Affectivity, Suggestibility,

Paranoia

By
Prof. Dr. E. BLEULER,
Professor of Psychiatry at the University of Zurich

Authorized Translation by

Dr. CHARLES RICKSHER,

Assistant in Clinical Psychiatry, Psychiatric Institute,
New York State Hospitals

UT1CA. N. Y.

STATE HOSPITALS PRESS

[Reprint from N. Y. State Hospitals Bulletin, February, 1912]

 AFFECTIVITY, SUGGESTIBILITY, PARANOIA.
By E. Bleuler,
Professor of Psychiatry, Zurich-Burgholzli.

TRANSLATED
Bv Charles Ricksher, M. D.,
Assistant in Clinical Psychiatry, Psychiatric Institute of the New York State
Hospitals for the Insane, Ward's Island, N. Y. City.

AFFECTIVITY.

Psychopathological investigation has finally reached a

point where we can go no further with the ordinary con-
ceptions and methods. On the one hand new conceptions
must be done in his experimental
created, as Krsepelin has
studies on the other hand, our general concepts and
;

general descriptive terms which are too indefinite and

which do not go deep enough must be replaced by more
exact ones. Confusion and stupor for example, are not
terms with which one can do very much one must know ;

upon which of many possible fundamental derangements

I hallucinations and delusions, flight of ideas, katatonic
parasthesias, retardation, blocking, apathy, etc.), such
disorders depend in any given case.
One of the best examples of how one may get lost in the
unfathomable by working with obscure ideas is shown in
the pathology of paranoia, and the attempt to explain
delusions by disorders of the emotions.
Specht^ speaks of an affect of suspicion
'
as a mixed '
'

affect" of pleasure and displeasure, without even touching

on the question whether suspicion is really an affect in the
same sense as pleasure or displeasure. In accordance with
his conception we would have to place pathological
suspiciousness by the side of the elated mood of mania and
the depressed mood of melancholia, whereas daily clinical
observation teaches us that there is as little resemblance

* Specht. Ueber den pathologischen Affect in der chronis'chen Paranoia.

Festschrift der Univ. Erlangen zur Feier des 80. Geburtstages seiner Konigl.
Hoheit des Prinzregenten von Bayern. Erlangen, Deichert, 1901.
between the disorders of paranoia (chronica; and those of
the affective psychoses as there is between the waves of a

stream raised by the wind and the current of the stream.

In order to proceed farther it will be necessary to attempt
the formulation of a clear conception of w hat we mean by T

the term affectivity, a conception with which we can oper-

ate and which comprises all that is meant by the terms
"feeling," "mood," "affect," and "emotion." As we
shall see the word "feeling" has too broad a significance,
while the meanings of the other three words are too
narrow.
Just as is the case in other fields, philosophical psychology
does not help us to clearly circumscribe our conceptions.
The Stoics in describing the feelings as " indefinite cogni-
tions,
'

'. had in mind something which in most text-books on

psychiatry is not included in the conception of feelings ;

they thought pre-eminently of intellectual processes. To

the scholastics the feelings were either a desire for the good
-or an aversion to the bad, in other words pleasure and dis-

pleasure, to which was added a certain ethical value, and a

special emphasis upon the voluntaristic principle which is
always contained in the "feelings." If Hegel calls feeling
"intelligence on the threshold of it's immediateness," and
Volkmar the becoming conscious of the degree of tension of
'

'

ideation, " we can not deny that these are words which mean
littlemore than nothing to the practical psychologist, the
psychopathologist nor are we any better off when we take
;

into account the explanations which are always indispens-

able for the understanding of such "definitions." Kant
expressed himself most clearly and correctly on this subject,
but without effect upon his successors however, whose
conceptions are not much clearer than those of the earlier
philosophers.
In the general part of the text-books on psychiatry we
find as a rule fairly clear statements. Here pleasure and
displeasure in combination with the affects represent the
concept to which we refer. But not infrequently psychi-
atrists go beyond this concept, the limits
of which are

regarded as self-evident and are not specifically stated. We

thus often are led imperceptibly to " feelings of security,"
to "the affect of suspicion,'' to " bodiry feelings," etc.
If we now seek to define in a practical and serviceable
manner the idea of feeling, mood, emotion, affect, we must
keep in mind the fact that we can make only a theoretical and
not an actual distinction between the different qualities which
are here concerned. Just as in the simplest sensations of
light, we differentiate between the quality (color, shade)
the intensity and the saturation, so may we speak of pro-
cesses of knowledge (intelligence), of feelings, or will, al-
though we know that no mental process exists in which all
three are not combined, even if now one, now another comes
into prominence. * When we designate a process as affective,
we know that this is an abstraction just as much as a color
conceived independently of its intensity. We must always
remember, however, that the process called affect has
also an intellectual and a volitional side, which we ignore
as irrelevant in a given case and that through continual
;

increase in importance of the intellectual and subsidence of

the affective factor, a process finally results which we must
designate as (mainly) intellectual. The same may be said
about will. We can not expect therefore to divide mental
Tiappenings into purely intellectual, purely affective and
purely will processes, but only into principally intellectual,
principally affective and principally volitional, while we
keep mind that many transitions exist.
in Theoretically,
however, we must keep the three different sides as widely
apart as, for example, the intensity and quality of a color
sensation.

Like all psychological expressions, the word " feeling"

originally designated something sensory ; it was synony-
mous with the modern " sensation " and this meaning un-
fortunately yet remains. We feel a prick, feel a fly crawl-
ing over the face, we feel a "feeling"
cold, or we have
'

that the floor shakes. ' two examples

Feeling '
' in the first
is synonymous with "sensation," a "feeling cold" is
*H6ffding (Lehrbuch der Psychologie, 2. deutsche Ausgabe, VI. A. 3) has ar-
ranged a scale from the almost pure affective common feelings to the almost pure
sensory perceptions. Lehmann also, according to Kiilpe, makes a similar scale.
usually a rather indefinite feeling, while in the "feeling- that
the floor shakes" lies a doubt as to the correctness of the
>,:
perception.
Thus the ambiguous word is entirely unsuitable for us.
Instead of it we will use the expression " Affectivity,''''
which shall not only designate the affect in the traditional
sense of the word, but also the slight feelings or feeling
tones of pleasure and displeasure which accompany all

sorts of experiences.
Thus the idea of our theme is fairly exactly defined. It

will occur to no one to designate the feeling of a prick, the

feeling of crawling ants, the feeling of swaying, by the
"
w ord affectivity, even though
T
afficere" originally had
also a more concrete meaning.
Difficulties arise only with the more physical sensations.
Sight, hearing and also taste and smell, are excluded from
the idea of feeling in German and English ; one feels

neither light nor tone, taste nor smell. On the other hand
the term feeling is ordinarily used with the sense of touch
and the other senses connected with the skin which are not
yet adequately defined.
It will be easy to separate from affectivity all that is
perceived or felt by these latter senses. But with the inner
somatic sensations and with pain there exists a certain
difficulty in regard to which we must attempt to get some
clearness.
The kinesthetic sensations (muscle sensations, joint
sensations, sensation of tension of the skin, ligaments,
tendons, etc.,) areas a matter of course only mere sensations
and have nothing to do directly with affectivity they are ;

analogous to the sensations of light and sound and give us-

information concerning the condition of the outer world, to
which in a psychological sense the body belongs. Or if the
analogy be not admitted we may say : they give us inform-
ation of the condition of the sensory nerves of the muscles,
tendons, and joints exactly as light sensation gives us
information of the condition of the retina.

* Other lanjjua.^es are no better in this regard. Fiihlen in German refers ta

sensation and perception as well as feeling'. Le sentiment du deja-vu is an
intellectual perception process just as the German Bekanntheitsgefuhl.
 But the condition of tension of the muscles has a special
•connection with affectivity : certain affects produce tension
in our muscles, others relax them, or the3r cause a different
distribution of tension in the different muscle groups.
Such forms and combinations of sensations* of tension
are physical accompaniments, or perhaps better, component
parts of affectivity. They have a certain value as regards
the position of our body —the amount of a movement must
be regulated according to the tension —but these sensations
scarcely enter consciousness as such, but they form, for
our inner perception, only a component of the affect and
are scarcely ever perceived independently.
Similarly palpitation of the heart is primarily a sensation,
a perception. Although this sensation is clear and well
defined, it is at the same time a symptom and a component
part of fear, of anxiety, or of joyful surprise, etc. The
same may be said of the sensation of heaviness or lightness
about the heart.
The majority of physical sensations which as such we do
not understand have almost no cognitive value. To be
sure we can ascertain indirectly that all our functions are
registered in some manner b}^ the brain, and have an influ-
ence upon the mind, but our conscious self has not learned
to so interpret the incoming stimuli that it knows when the
stomach secretes much HC1, when the liver forms this or
that chemical compound in greater or lesser amount, etc.
Thus we can scarcely call these centripetal functions
sensations, and it is therefore quite natural that we should
still speak of ''bodily feelings." Their connection with
the affects is a double one, a centripetal active and a ( )

certrifugal (or passive) one. All bodity sensations actively

influence our mood and even our affects. Thus the depres-
sion associated with disorders of the stomach is well known,
a small panaritium makes us irritable, etc. On the other
hand physical functions (the heart, vessels, intestines,
glands, etc. ) and through them the bodily sensations are
influenced b3 r
affectivity. As far as we become conscious
of these bodily changes we are concerned with a cognitive

*This not to be confused with the psychical tension-feelings of Wundt which

-*re not feelings in our sense but perceptions of inner conditions.
process, i. e., with something' intellectual; for the rest they
are " symptoms " of the affect.
Hunger and thirst are often reckoned among the affects-
or at an}- rate the feelings. They are composed of sensations
(aching in the stomach, burning in the pharynx, sensations
of weakness in the musculature and in the mental appara-
tus, etc.,) and feelings of displeasure, associated with these
sensations as well as with the general condition. The
sensations naturally belong to the cognitive processes, to-
the intellect in its wider sense, while the feelings of dis-
pleasure belong to affectivity.
The position which pain occupies is not entirely clear to-
me. Is it essentially a sensation or an affect? Or does it,
like hunger, belong partly to each ? The latter seems to me
to be the most probable. At any rate it has a sensory
component or we could not localize it. Moreover it possesses,
like a sensory function, special tracts in the spinal cord and
brain stem, perhaps even in the periphery. But it is strik-
ing how diffuse is its localization in the cortex and that
analgesia or hyperalgesia may so readily be produced
through mental influences. It is for intance much easier to-
produce analgesia than anasthesia by suggestion.
We might imagine that these specific sensations of pain
are accompanied by such a strong feeling of displeasure that
the latter appears as the most important, as the essential
element, so that this most frequent kind of displeasure has
become the prototype of all negative affects, and we speak
in a figurative sense, of mental pain and of painful affects
in general.
The fact that displeasure, as it seems, may sometimes be
separated from the painful affect and may even be replaced
by a pleasure, also speaks for a parallel between pain and
hunger, i. c, for the supposition that it is a special sensation
with an unpleasant feeling- tone. With slight pains, such
for instance as cause one to touch the affected spot again
and again (hollow tooth), it often appears that an increase
of pain within certain narrow limits may be connected with
a feeling of pleasure. Even excluding masochism, we
must also remember that there are pleasurable sexual pains.
 .

Further there are hysterical patients who perceive pain as

such (who are therefore not analgesic) and in whom this
pain is associated with pleasure. The amphichromatic
tickle and the positive sexual pleasure also show a similar
combination of sensations with strong affects.
All that we have described above as sensation, or broadly as
a cognitive process, i.e., as an intellectual function* must be
sharply separated from the conception of affectivity
distinction which we have made in the centri-
The same
petal,must also be made in the more intracentral processes.
Indeed Nahlowsky long ago separated the "intellectual
feelings" from the affective ones, yet not so clearly that his
separation was generally understood. t He understood by
intellectual feelings, indefinite perceptions, conclusions and
ideas which influence our actions. These act only cumula-
tively and therefore without becoming clear. According
to him we appeal to these "feelings" only when we lack
sufficient ground for a view, assertion or conclusion, or
when we know the grounds in a general way but are unable
toproduce them individually and in logical sequence. Thus
wo'men, according to Nahlowsky, are usually led to their
views and conclusions by such feelings.
Nahlowsky therefore in speaking of intellectual feelings
has in mind conclusions the premises of which or the
chain of logical reasons of which remain partly or wholly
subconscious.
Such conclusions and ideas which lack a clear back-
ground are very common and play an important part in
life, and it is, for example, quite true that women often allow

their actions to be governed more by such "feelings " than

by conscious reasoning. I may have the feeling that such

* According to Wundt "objective" process is opposed to "subjective" feeling'.

t Others (Wundt, Ziehen) call " intellectual feelings " such feelings and affects
as accompany composite intellectual processes, in contradistinction to "sensory-
feelings." Thus employed the term naturally expresses an entirely different idea
from that of Nahlowsky's terminology, whose conception of "intellectual feel-
ings" we shall often have occasion to use.
The French also (P. Janet, for example) speak of " sentiments intellectuals"
by which among other things are understood sentiments du deja vu, du
:

jamais vu, de nouvaute, d'etrangete, d'incompletude, and even de cicile. The

idea here also is broader than with us and has as little to do directly with
affectivity as that which we designate by the name of intellectual feelings.
 s

a person's wishes are against me, or that X is a rascal

or a fine fellow, or I may have a feeling that a patient
has typhoid But in none of these examples do
fever.
I know why have
this feeling.
I I would be unable
to prove its correctness, though I may add that I make
fewer mistakes in my preliminary judgments about per-
sons if I follow my instincts than if I try to follow my
conscious reasoning.
'

All these examples of

are intellectual feelings in '
;
'

Xahlowsky's sense. But we must get a more comprehen-

sive idea without deciding whether we then depart from the
authors or not.
The majority of psychologists, including Xahlowsky,
conceive of feelings" as a species of reactions of our
mind to an}- process, especialh^ one of a centripetal char-
acter. Such reactions may naturally be intellectual as well
as affective. Thus Lipps* describes a purely intellectual
'

process when he says. ' I feel certain

'

' or when he speaks

of the ''feeling of certainty." He expresses by the word
"feeling'' the knowledge that he thinks or understands
correctly. This cognition may' be accompanied by a feel-
ing of pleasure or displeasure, according to the content of
the thought I am certain that my friend deceives me or I
I

am certain that I will be promoted I . Here affectivity is

something entirely incidental. The "affect of suspicious-
ness " as used by psychiatrists is somewhat different. This

expression does not signify that I have a feeling or inner

perception, for example, of being suspicious, but rather a
feeling that perhaps some one may do me an injury, in
other words simply an indefinite idea which according to its

content is accompanied by more or less feeling-tone. The

corresponding affect need not always be negative. Thus,
for example, if in his attack my opponent gives me an op-
portunity to render him harmless, or if suspicion seems to
be directed not toward me but toward my enenw, the affect
is positive.
The same may be said about the "feeling of truth " and
the " feeling of probability
"

of which Lipps speaks.

;

If

*Lipps. Voni Fillilen, Wollen and Denfcen, Leipzig, Barth. 1002.

 '

we recognize or logically conclude that something' is true or

probable, this is a purely intellectual process, and it is the
same when we become conscious of knowing something to
be sure or probable, i. c, when we have the conscious feel-
ing of certainty or of probability.
There is great confusion also in the example, '
T feel sad,
'

which Lipps mentions. While this seems to be essentially

an affect, the expression indicates in reality only the process
of inner cognition, the perception that we are sad, the ap-
preciation of the inner condition, the consciousness of sad-
ness. That which is described by the word 'feel" here would
'

remain exactly the same whether I felt happy or sad, just

as the perceptive process as such is the same whether I see
a cat or a dog.
All this we designate as intellectual feeling, not only
because the expression was coined for it b\ Nahlowsky, r

but also because the uses of speech stubbornly designate it

as feeling. But we must clearly remember that this sort of
feeling has nothing to do with affectivity but represents
intellectual ( objective) processes. To repeat :
" Intellectual
feelings" are one thing indefinite perceptions, con-
for
clusions and ideas, as in the above example when we feel that
a patient has typhoid without being able to explain why ;

and they are also inner perceptions, as in the case of the

"feeling of certainty." These two kinds of intellectual
feelings can not be so easily separated practically as one
might theoretically expect. For example, we speak usually
of a " feeling of certainty " when it rests on an indefinite
conclusion or perception although the expression as such
;

would designate rather an inner perception, it is as a rule

only used when it comprises, at the same time, an indefinite
cognition.
These intellectual feelings under certain conditions play
a great role when combined with affects. I have already
pointed out that women commonly act according to their
intellectual feelings. We must not forget that in our ordin-
ary decisions of life we seldom have a chance to make all
the motives of our acts clear to ourselves. In a discussion
we scarcely have time to grasp our opponent's point of view
 10

in all its details and to make it clear to ourselves which of

the many possible ways is the best to overcome him. We
reply in an irritated, friendly or deferential manner accord-
ing -

to our intellectual feelings. Shyness, a mixture of

indefinite cognition that someone might do someihing
harmful or injurious to him, and the affects which are
associated with this, sometimes completely control the con-
duct and thoughts of a child, etc. On the other hand we
find that under certain circumstances the feelings with their
inhibitions and promptings seem to take the place of logical
thinking almost entirely, so that the conduct becomes purely
instinctive. (Compare the examples of such reactions in
children detailed later on).
To sum up we may add that the word "feeling" means
common speech but also in psychology many
not only in
different things such as :

1. A large number of contripetal processes, sensations,

perceptions (feelings of warmth, bodily feelings).
2. Intracentral perceptive processes:
a — With reference occurrences outside the body,
to
feelings of certainty, of probability).
(

b — With reference the internal conditions, (feelings

to
of sadness ; sentiment de cecite).
3. Indefinite or unclear cognitions, whether it be direct
perception or a conclusion the elements of which are un-
clear or subconscious. ( 2 and 3 are united under the name
intellectual feelings ).

4. The feelings of pleasure and displeasure, to which we

must add the affects, the affectivity.
1 —
3 ARE INTELLECTUAL PROCESSES WHICH ARE EN-
TIRELY DIFFERENT FROM AFFECTIVITY AND SHOULD NOT
BE CLASSED WITH IT.
This is not merely an academic separation. It is neces-
sary in order to study the mode of action of affectivity, and
IT IS ONLY AFFECTIVITY IN THIS NARROW SENSE THAT
HAS DEFINITE EFFECTS UPON THE BODY AND MIND. The
other functions separated from it signify in themselves only
some other definite or uncertain cognitions.
 11

Whether I
'

' feel
'
' my intestines or not, whether I have
a feeling of "certainty" or of "suspicion," this is all com-
paratively irrelevant to my mind so long- as no affect is
associated with these feelings. As soon as an affect is

added, immediately dominates the whole mind.

it

It would carry us too far to attempt an enumeration of

all the modes of action of affectivity. I should like to

citehere only a few that are practically important.

Let us take the reaction of an amoeba quite independently
of the question whether its functions are accompanied by
consciousness or not.
The stimulus of a particle of food acts upon a certain
definite spot of its body, a pseudopodium is sent out which-
surrounds the food, digests it, throws out the indigestible
part and again the amoeba takes its original form. That
would be the localized objective, " " intellectual" process.
'

'

But the nutritional tonus and the entire condition of the

amoeba must also have changed. During the seizure of
the food other parts of the body should not reach out in
other directions, and such efforts had to be inhibited. The
taking of food benefits the whole individual; it grows
stronger, becomes more prone to fission and to carry out
other similar functions, and the general mobility of the-
granules'becomes livelier, etc. These general reactions of
the amoeba may be compared to affectivity. Naturally
such general reactions accompany not only the act of
seizure and digestion of the food, but, as in the higher
animals, they must begin when the food-stuffs became
noticeable, during the act of perception, if we dare use here
a term which assumes the existence of consciousness.
In man numerous physical phenomena are associated
with an affect (conditions of heart, vasomotors, muscle-
tonus, metabolism, tear glands, intestinal glands, sweat
glands, the entire involuntary musculature, etc.). Much
more important, however, are the psychical accompan-
iments.
An affect generalizes a reaction, or we may express it

quite as correctly by saying: An affect is a generalized'

reaction.
 12

A prick in my finger causes me to withdraw the hand. If

I am frightened by it, I become angry, then
run away; if I

I attack. But it is not only the body which is influenced.

If I am alarmed, because the prick may remind me of a
snake, then all considerations which might hinder nry flight
become more or less repressed and the thought of avoiding
danger becomes the dominant one. If I become angry I
may strike out even though it may not be the wisest thing
to do; yet I am quite convinced at the time that I am
warranted in so doing. Thus in the presence of an affect
all opposing" associations are inhibited, whereas those in
harmony with the affect are facilitated.* The momentary
force of our actions is thereby naturally increased (even
when the actions are negative, such as a persistence in a
given condition).
It is easily understood that associations which do not

harmonize with an affect can not all be entirely suppressed.

If they are of an indifferent nature, the affect is readily
transferred to them. The place where something unpleas-
ant has happened to us is hated. We often hate not only
the one who does us an injury but also accidental bystand-
ers, and this feeling may remain connected with them for a
long time or forever. The carrier of a bad message is
hated.
Through this transference of the affect (irradiation.) its
influenceupon actions naturaby becomes further increased
and deviations from the course taken are opposed as much
as possible.
The affects have the further peculiarity of lasting longer
than the actual experience. A pleasant experience tends
to leave an agreeable mood for a long time. Anger often
increases to fury some time after an unpleasant occurrence.

*The Emotions and the Will, by Alex. Bain. 3rd Edition. 1875. " The influence
of feeling on belief is of a mixed character. In the first place it would arise in
the ordinary action of the will. We
are not easily persuaded of the ill effects of
anything we like. In a state of strong excitement, no thoughts are allowed to
present themselves except such as occur in the present mood. Our feelings
pervert our convictions by smiting us with intellectual blindness, which we
need not be under even when committing great imprudence in action. It
depends upon many circumstances what intensity of emotion shall be required
to produce this higher effect of keeping utterly back the faintest recollection of
whatever discords with the reigning fury."
 13

Whoever has seen something" worth striving- for which

has excited his affects, will endeavor to gain it, even when
the object has been removed and the duration of his effort
;

will have a definite and direct relation to the strength of

the affects. In this way affectivity determines perseverance
in our actions.
The hindrance judgment brought about by affects
to free
may often be more disadvantageous than useful.
seem to
Decisions made under the influence of emotion are rightly
looked upon as questionable. I^or instance, one does many
foolish things in anger, in despair, and in love, which he
would not do under other circumstances. Even negative
affects, like fright and anxiety, may render us defenseless to
danger. These, however, are exceptions which are, rela-
tively, very infrequent. Still, even these maximal affects,

which often overstep the mark, may be at times of advan-

tage, as is the case with the strength of desperation. The
affectswhich are well adapted to our needs are those which
occur constantly and which are of moderate degree they ;

are as a rule scarcely noticed. How often does a little im-

patience help us over a difficulty? An irritable tone of
voice often suffices to get rid of disturbing persons.
Children who often do not know what danger is, would be
lost as soon as they left their mother's arms if anxiety
caused by unknown and indefinite perceptions did not keep
them from harmful actions.
And in important matters too it is our affectivity which
overcomes the obstacles. Suppose we are facing a difficult
undertaking so long as we view it coldly we can not
;

resolve to take hold of it; the obstacles seem to be too great,

too many considerations must be put aside. But when
suddenly our enthusiasm is aroused for the task, then it
seems to be the only thing worth working for; all other
considerations are forgotten or at any rate put aside all ;

mental and physical strength is set to work for the one

object. Then and only then is it possible to gain what we
desire.
Affectivity, therefore, far more than reflection, is the
determining element in our acts and omissions. Probably
 14

we act exclusively under the influence of feelings of

pleasure and displeasure. Our logical processes derive
their dynamic force only from the affects combined with
them.* There are many people who know exactly what
they should do, but who do nothing because they lack the
proper affects. All instincts so far as we can observe them
in ourselves, or analyze them in lower animals, are asso-
ciated with affects. Hence the affects are connected not
only with cognition but even more closely with volition. I
might better say that affectivity is the broader conception
wherein volition and desire represe?it only one side. Affectivity,
which is one with our instincts and impulses, deter-
mines the direction of our endeavors. Logic, judgment,
seems on careful examination to be only the servant that
shows the way to the goal and furnishes the necessary
apparatus. Harry Campbell says rightly that men preach
'

what they think, but they do what they feel. It is self-

evident that the moral worth of a man

depends entirely
upon his moral feelings. He to whom the good does not
appear beautiful and agreeable, who has no abhorrence of
the bad, who lacks sympathy, will act badly, even though
his logic under special or general circumstances surely
warns him that it would be better for him to behave him-
self (moral idioc} ). 7

On the whole we are always striving for experiences

accompanied by agreeable affects and we avoid the opposite
as much as possible. Conflicts often arise from the fact
that the attainment of one pleasure often excludes the win-
ning of another, that one of two evils must be chosen,
that often that which is now agreeable will be disagreeable
in the future. All these and other similar propositions are
well known common-places.

* In psychopathology the affects in the vast majority of cases are the index of
the whole picture, and it is easy to reduce the disorder to them, as, for instance,
in melancholia and mania. In dementia praecox, where the affectivity is inter-
fered with, there is a lack of effort, a failure to try to overcome obstacles, even
when the intelligence is not much injured.
 15

It is remarkable how little attention has been paid to the

mechanisms which allow ns, through influence upon mental
processes, to render affective experiences as pleasant or as
littleunpleasant as possible. The more intelligent and
cultivated a man is the less does he live in the present, and
the more important do the past and future become.
The past remains a part of our Ego and forces us to come
to an agreement with it. We rejoice over past happiness,
grieve over the injustice we have suffered, and the evil
things we have done torment us as remorse and force us to
atone.
The future rules us even more distinctly and more con-
stantly. Anxiety and hope determine a great part of our
present acts. They even go beyond the grave in the
endeavor to secure a place in heaven. They go beyond the
future when unselfish solicitude for those we leave behind
guides our acts. Generally speaking, however, we try to
form for ourselves a future with as many comforts and as
few discomforts as possible, and to this we devote the
greater part of our energies.
In pathological conditions and in dreams, anticipated
feelings attain special significance, since in wish-dreams
and in wish-deliria, which latter are frequent not alone in
hysterical states, they present the fulfillment of desires.
For example, a woman in love may dream or imagine in a
delirium that she is the wife of her beloved.*
There are also wish-hysterias, besides delirious conditions,
which represent a fictitious wish fulfillment. The wish
may then become fully realized. A prisoner, for example,
under indictment who is more or less clearly convinced that
it would be well for him to be declared insane, may acquire

a mental disorder, but a mental disorder as he understands

it (Ganser's complex ).f

A very altruistic woman is fired with a desire for political

progress. Neither her strength nor her circumstances allow

*The influence of affectivity on the mechanism of the normal and abnormal

mind has first been shown in its proper light by Freud.
t Compare the beautiful case of Jung {Jour, fur Psychologie and Neurologie^
IQ03). An originally voluntary simulation has gotten beyond the control of the
patient and has become an involuntary delirium.
 16

lier to carry out her ideals; nevertheless she must talk

about thern and become enthusiastic over them. The con-
trast between what she says and what she does, between
her ideals and the realities, would render her ridiculous; but
she would avoid this if she became ill. So on the occasion
of an unhappy love affair she acquires hysterical attacks,
hj'-sterical deliria, which naturally resist all treatment, since

a causal treatment, the removal of the above-described

conflict, is not likely to be effected for a longtime. This
"flight into disease" is a very frequent cause of hysteria.*
A student in the gymnasium who would
like to be
among overwhelmed with work. If he
the best pupils is

should have a headache, like his comrades A and B, the

properly completed exercises might not be required of him.
So he acquires a headache, but it is real and very unpleas-
ant, and it only leaves him a short time after it has ceased
to be useful to him.
The an injury in a railroad
father of a family suffers
accident. How he should no longer be able to
dreadful if

provide for his family! At present he is doing fairly well,

but such things can subsequently grow worse as well as
better. And suppose he should have to go on with his
occupation half able to work and always in pain ? After a
late turn for the worse, no one would connect it with the
injury. It would be better if he were dead or totally —
disabled. The lawyer tells him that his income capitalized
would amount to 80,000 frs, and he could demand as much
in case he were incapacitated. His family might thus be
provided for permanently. Does not everything point to»

the fact that he will need to have this money? His sleep is

already irregular, his work taxes him to the utmost, pressure

on the head appears, the railroad travel required by his
business causes anxious dread, even anxious seizures.
How very necessary it is to prove the existence of a severe
disorder and obtain the 80,000 frs., etc. The traumatic
!

neurosis or psychosis is now established and at best can

only be cured after a favorable settlement of the suit.
ll
All these wishes" here referred to are naturally not clearly

* This "flight into disease" has been very well described by Selma Heine in.

her novel " Peter Paul,'' although in an individual who was not hysterical.
 17

conscious to the individual. The mechanism of their realiza-

tion is wholly outside of his knowledge. His acts are bona
fide.
We have now been drawn into a region to which we have
dedicated a special chapter, that of suggestion, or auto-
suggestion. The examples given lead us to anticipate this
investigation and to say that feeling alone, affect with its

well known sequelae, and not some other particular mechan-

ism, fulfills the wish, realizes the auto-suggestion.

The past can not be changed ; the remembrance of it is

often associated with very lively positive or negative affects.

There are people who live on the remembrance of former
happiness and are thereby happy. Anger due to injustice,
remorse on account of wrong one had done, pain due to
some loss, may embitter life for many years and outweigh
actual sorrows.
The means by which we seek to preserve the pleasant
feelings of the past have been as yet little studied, even
though mcminisse juvabit expresses an old truth. The
past seems to be most easily revived by. so arranging-
external conditions that memory is kept awake, and all
other impressions are avoided. Some persons who have
lost some one dear to them do this by leaving the rooms
and everything in them undisturbed in order that the past
may continue to live in the memory. For the same reason
we revisit the scenes of former happiness to revive the old
feelings in spite of changed conditions. There may be
other methods of a more psychological nature, but as yet we
do not know them.
Thanks to the investigations of Freud we have learned a
number of mechanisms which enable us to make painful
feelings associated with past experiences as innocuous as
possible. These mechanisms play an unexpectedly im-
portant role in hysteria, the obsessions, dementia praecox^
and probably other disorders.
 18

It is shown most clearly in pathological cases that affec-

tivity, opposed
as to cognitive processes, has a certain
independence, that affects may separate themselves from
some intellectual processes and connect themselves with
others. It is well known may spread, and that
that they
they nia\^ invade, as far as time and content are concerned,
other mental experiences associated with a decided feeling-
tone. Thus morning experi-
a disagreeable but transitory
ence may spoil the mood
whole day; the erotic
of the
affect which originally concerns only the loved one may be
carried over to the rosette which she wears upon her
breast, etc.
Affectivity moreover shows its independence in regard to
the intellectual processes in another way, for the same per-
ceptions, the same experiences, can
alter according to the
even according to our bodily, disposi-
intellectual, affective,
tion. To the one who has just eaten, a meal tastes less
pleasing than it does to a hungr5 man; when we are in an r

irritable mood the music which we hear with pleasure

under other circumstances annoj's us when we are tired a ;

lively play of colors which would be otherwise very agree-

able, awakens in us a feeling of displeasure.
To be sure there may be another explanation for this.
The idea of a meal does not stand alone in our mind. The
content of consciousness consists rather of a mass of indi-
vidual factors, among which the condition of satiety or of
non-satiety is also an important one. Therefore the
mental content is not the same when we eat in a hungry
state as when we eat already satiated. un-
It is not at all
likely that the emotio?ial reaction is produced not only by the
sight and taste of the food, but that it corresponds to the entire
mental content at the time. If this hypothesis is correct it is
easily understood that the same affect can not always
correspond to the same individual partial sensations be- ;

cause the affect corresponds in reality only to the whole

mental content. Hence we need not assume that our enjoy-
'

ment of a beautiful painting is impaired by disagreeable

'
'
'

surroundings. In our mind the view of the picture and the

environment are a whole with which the affect of pleasure is
 19

Tiot associated. The pleasure of hearing a piece of music

is then not an affect related to the music, but an affect
called forth by the music in association with our psychic
and nervous disposition. We would react emotionally to
the piece of music alone as little as we would under ordin-
ary circumstances to the sight of a knife. But if the knife
is in the hand of a suspicious looking individual whom we

meet in a lonely wood the liveliest fright can be provoked.

A sure indication of the independence of affectivity is the
great variation in emotional reactions in different individu-
als to the same intellectual processes. The variation is so
great that we have no means of determining what is
really
normal and what pathological. According to the ruling of
German courts complete defect of moral feeling (i. e., the
absence of an emotional tone which would normally be
associated with moral concepts) does not count as patholog-
ical unless it is accompanied by intellectual abnormalities.
with the intellectual processes among
It is quite different
which we must reckon the "intellectual feelings" as
already defined in this chapter. They are indeed somewhat
more variable, because more subjective, than the primary
intellectual processes, sensation, perception, etc., but they
may be compared to the logical faculties which also show
individual differences. Our perceptions present within
normal limits only very narrow variations, our logical
reactions slightly greater ones and where these functions
;

are but little defective the abnormal condition is at once

perceived by the laity. When we have parafunctions of
these processes (hallucinations and delusions) the} are, r

even when mild, quickly noticed as pathological, while as

regards affectivity it is impossible in many instances to
distinguishbetween paraf unction and normal function,
since the same object may liberate in the one esthetic feel-
ings of a positive, in another of a negative character.
Moreover there is also very little relation between the

distinctness of emotions and the distinctness of intellectual

processes. Indeed unclear processes (e. g. intellectual feel-
ings) are very often accompanied b}^ especially lively
affects.
 20

The development of the intelligence furthermore is

related in no single direction to the development of affec-

tivity. Affectivity is fully developed in the young child;
all the emotions of adult even the most complicated,
life,

are already present. The intelligence of a child on the

contrary has no content and the logical processes are rela-
tively feeble. One who remains intellectually at the level
of development of a child is an idiot. But one who has the
affectivity of a child is not less well endowed with feelings
than the normal man. The difference is that the feelings
by the intelligence.
in the latter are not limited
Moreover in adults the liveliest feelings, in the esthetic
sphere, for example, may be united with the greatest stupid-
ity, and inversely supra-normal intelligence may be associ-

ated with defect of these feelings. Morality, that is, the

affective tone of moral concepts, is likewise wholly independ-
ent of the development of moral concepts themselves. Indeed
a certain intuitive morality ( love, capability of self-sacrifice,
etc.), is often present in the lowest idiots while the corre-
sponding concepts are nearly wholly lacking. These
or
cases should be contrasted with moral idiocy, and may
make it clear to those psychologists who, in spite of the fact
that an independence of affectivity and intelligence is
accepted in other spheres, are surprised that there is such
a thing as moral idiocv.

The independence of affectivity reaches so far that affects,,

and especially moods without intellectual substrata, may
develop directly from bodily feelings or physical conditions.
Disease of the stomach may cause ill-humor; valvular
heart disease anxiety; and tuberculosis of the lungs
euphoria (just as euphoria is produced by health of all the
organs). The nerve-poisons, especially alcohol, are used
because of their definite actions on affectivity.

As affectivity allows greater space for individual varia-

tions than do the intellectual functions, so also is the defense
 21

against unpleasant feelings very different in different

persons and circumstances. We shall certainly come some
day to the classification of a number of types which shall
represent more distinctly what was sought to be expressed
by the old classification of temperaments. For the present
I can only allude to what I mean.
Many individuals who resemble somewhat the classical
sanguine type, react quickly and intensely to emotional
impressions, but the affect rapidly passes away. When the
storm is over they are the same as before. It is as if they
exhausted the affect by their outward reactions, by the
hurrahing, weeping, scolding, or striking blows. If the
affect be repressed against the natural disposition, it is
likely to lead under conditions which as yet are not well
defined to shuntings and conversions in the sense of Freud's
pathological reaction. Subsequent "unburdening" (Abre-
agieren) may then under certain circumstances cure the
morbid symptom or symptoms which have been caused by a
"'converted" affect. Women and children seem to exhibit
this type more frequently than men.
Another group of individuals, of easily excitable nature,
do not take a strong disagreeable affect into their whole
personality. They dissociate the affect together with a
large complex from their personality. They are entirely
normal when they think of things having nothing to do with
the affect and its associated intellectual processes. The
affect does not exist for them nor are the related ideational
processes associated. A love affair, which has turned out
badly, together with all the associations of the Ego-complex
•concerned with it may, so to speak, be cut out of the
person. The affect is revealed chiefly in unconscious acts
which betray a connection with the experiences of the
love affair. A patient whose lover had shot himself forgot
the occurrence, but in a casual conversation pressed rose
leaves to her temple with a little snap, quite unconsciously.
This could be demonstrated to be what Freud calls a symp-
tomatic act ( Symptom- handlung) If, however, the affair or
.

anything associated with it be mentioned, the affect is im-

mediately revived and with it the remembrance of the whole
: story.
 22

It is evident that these types when pronounced are pre-

disposed to hysterical deliria, since the dissociated affective
personality often possesses too few associations related to
actuality, and transforms the actual experiences in accord
with the affective idea-complex.
In a third type the affects develop slowly. They re-
quire a longer time to reach their maximum, but then
remain long" active. Lively expressions of feeling occur
less often ; the affect is repressed. Such individuals protect
themselves from the influence of disagreeable affects by not
thinking of the experience, which can only be successful
by avoiding also, as far as possible, the associations related
to the unpleasant occurrence. Thoughts and occupations-
are so arranged that, as far as possible, the disagreeable
occurrences are not recollected and that undesirable mem-
and not remain to be pondered over
ories shall be fleeting ;.

consequent^ they have no time to revive the more slowly

moving affect. Hence the affect is suppressed though it
still remains, despite this, always read} and capable of 7

association. The unpleasant experiences are likewise

every moment accessible to memory. Remembrance is
simply avoided, but is always possible at an}' instant. The
intellectual feeling that certain thoughts must always be
avoided, a sort of heaviness of heart, which gradually
diminishes, proves the persistence of the repressed affect. If

itagain becomes actual through remembrance, it dominates

the whole personality as at the time when it was new.
A temporary, complete dissociation is also possible in
this type. An unpleasant experience that can not at the
moment be gotten square with because of other duties,
and consequently can not be disposed of, is dissociated,
completely forgotten. While the other occupations continue,
neither the feelings nor the occurrence exist in the conscious-
ness ; it is only later that it re-emerges and has to be elabo-
rated and disposed of.
If suppression of the affect is wholly successful, so that it
exists no longer for consciousness, it is often converted"
'
;.

instead of the affect, some physical symptom appears, a pain,

an hallucination. A patient described by Riklin* had ear-
*Psy chia trisch-neurotogische Wochenschrift ', igo^-iqoj.
 23

ache whenever she put on a certain jacket, a jacket which

she had worn one winter day in the woods when she had
given birth to an illegitimate child and at that time had
contracted earache. The connection was completely un-
known to her, the jacket reminding her neither of the birth
nor of the affect.
In dementia praecox affective experiences are transformed
into hallucinations, delusions, stereotypies, all generally
having some obscure symbolism, while the original affect
can not be demonstrated or is rudimentary (vide the works
of Jung and Riklin. Journal fur Psycho logie zmd Neurologic,
1904, also Jung, Dementia prce cox; Halle, Mar ho Id, 1906).
There are doubtless many such mechanisms by which
disagreeable affects are gotten rid of. A knowledge of
them will make the symptomatology of the abnormal as
well as of the normal mind more comprehensible, and at
the same time will afford us some help for treatment.
Among the emotional experiences which give rise to the
phenomena we have described, sexual matters play a very
important part, though perhaps they do not so completely
dominate the symtomatology as one might believe from
reading Freud's works. There are important reasons why
. women are more influenced thereby than men, aside from
the stronger sexuality of women, which, however, has been
unduly emphasized. In the average woman her whole
career depends on the sexuality. Her instinct of self-
preservation makes use of the sexual instinct. To her,
marriage means that which to a man means success in busi-
ness, ambition in all directions, a well-conducted struggle
for existence, enjoyment of life, in addition to sexual
pleasures and the joy in children. That which to the average
man appears to be relatively or absolutely unimportant,
not to marry or illegitimate sexual indulgence, has for
women far-reaching results marked by the strongest affects.
And the foolish restrictions of our culture make even the
thought of these questions impossible to a well-bred woman,
requiring not only the suppression of all acts in that
direction but the suppression of the sexual affect itself. It

is no wonder that under these circumstances one meets in

 24

women patients at every turn converted, repressed, dis-

placed sexual feelings, those feelings which make up at
least half of our natural existence. I say at least half, for
the analogous instinct, hunger, seems to retreat before the
sexual and this is true not in the case of civilized man
only, for whom in the majority of instances the struggle for
food is either unnecessary or comes into play in a very
indirect manner.*

One of the most important manifestions of affectivity is

attention.^ We are attentive to processes or things which
interest us. Furthermore we can force the attention to
turn to other things, but we always have an affective basis
for so doing. In such event it is an indirect satisfaction of
an interest, as when I read a tiresome book, which it is
necessary to do in connection with my work which interests
me, or when I give myself up to a psychological experiment,
the results of which are to satisfy my desire for knowledge ;

or when in order to keep away discomfort or to gain

comfortswe perform tiresome labors for food or money; or
when one works to avoid punishments as in the case of a
slave or a convict.
Therefore a personal and actual interest lies at the basis
of passive attention, while an indirect interest, with an
affect similar to that of fear and hope, lies at the basis of
active attention. Naturally all affects which are not here
named can dominate the attention. Those cited are only
those which are most frequent in daily life. Everything
which excites an affect, anxiety, fear, joy, love, attracts
our attention to it.+

* By sexuality is understood not only coitus but above all the many affects

which are connected with sexuality. These latter often play a more important
part with women than sexuality in the limited sense. I know a woman who
was very neurasthenic and who certainly suffered fro-.n unsatisfied desire for
love; she married, became markedly better, and is now perfectly happy, although
coitus has never been successful.
+ Stransky rightly says " attention = interest,'' which latter corresponds to
feeling, and is a part of affectivity.
% There are whole volumes of pedagogic wisdom in the simple formula The :

attention of a child can be turned to and really grasp an object only if the
teacher can bring it into connection with some idea associated with a strong
affect.
 25

What we know of attention is the fact that it causes all

these perceptions, associations, and movements which are

related to an object of interest to be stimulated, all opposing
ones to be inhibited. This we already know as the action
of affects. When I turn my attention to the problem of
attention, all the associations belonging to it are facilitated.
Each portion of the problem has its own particular interest.
At first my attention was turned to the affects which
aroused the attention, now it is turned to the associative
changes which attention creates. All these particular
associations are facilitated, others inhibited.allWithout
this direction of the thoughtsby interest, by the aim of my
work, I could just as well have passed from this idea of the
associations to the work of Jung and Riklin, then to that of
Aschaffenburg, then to the cathedral at Cologne,* etc.
These would never have appeared in conscious-
last ideas
ness while writing this, if I had not needed an example of
the kind of associations which are ordinarily inhibited
under these circumstances. I have here made such a
series of associations for the first time, despite the fact that
I have been occupied with the problems of attention and
associations for years past. But such a series is closely
related to free association, also to "flight of ideas." We
come now to that which Paulan years ago designated bj T

'

the name of by which he meant that the

'

' loi de la finalite '

ordinary laws of association did not suffice to explain the

train of thought if the purpose or ultimate aim of the train
of thought were not also reckoned with as a definite
factor.
For us it suffices to know that attention as well as our
whole conduct is always directed by affects; or better ex-
pressed: Attention is one side of offectivity which does nothing
else, as we already know, but facilitate certain associations and
inhibit others.
In the process of facilitation we naturally have to
consider not only the intra-central and centripetal, but also
a mass of centrifugal connections. The readiness of the
senses, the adjustment of the eye for example, or the readi-

*Prof. Aschaffenburg resides in Cologne.

 26

ness of the muscles for action in harmony with the affects

should not be forgotten. When a cat fixes its attention on
a mouse hole it is always in readiness to seize the pre}', as is
shown by its position and the relative tension of all the
muscles. When we say that anxiety makes us ready for
flight or defense, it is the same as saying that we have
turned our attention to the object of anxiety and to the
accompanying reactions. The well known
theory regard-
ing the origin of melancholic delusions can be described
as well in terms of the affect as in terms of attention: it
has been said that in states of depression only depress-
ive ideas can be associated, while others are inhibited.
One might equally well say that the attention being
fixed upon no others can come into
sorrowful ideas,
consciousness. The processsame as when an investi-
is the
gator puts forward a false theory and then spends the rest
of his life in finding support for it, meanwhile over-looking
all opposing evidence. His attention is given only to the
former, he has interest only in observations that help his
cause.
Attention is therefore nothing more than a special kind of
affective action.
As the forms of affectivity change so do those of atten-
tion. In the organic psychoses the affects are fleeting; it is

the same with attention. The manic patient colors every-

thing that occurs to him with his constantly predominant
positive feeling-tone. He is therefore interested in every-
thing, in trivialities as well as in the important things. This
leveling of ideas" necessarily causes distractibility by
external happenings. A further consequence is the flight
of ideas, though 1 would not say that other causes may not
contribute to the genesis of this symptom. In dementia
praecox the affects are more or less repressed, interest is

often entirely lacking, and attention is also lacking. The

flow of ideas is without direction. The ideas are connected
with an} given idea in a very bizarre manner and without
-

selection.
These allusions may suffice to illustrate the meaning of
our conception for psychopathology. I do not think that
Ave express views with which all our colleagues are
familiar. .

More popular at present than this associative conception of atten-

tion is a dynamic theory which sees in a concentration of cerebral
or mental forces, or evena greater exertion of them, the
in
essential nature of attention. This interpretation often starts from
the feelings of fatigue. At present we can't do anything with the
latter in a psychological analysis, for we are entirely ignorant of their
origin. It is possible that even in purely mental exertion of the
attention, the never-failing tension of certain muscle groups (eye
muscles, muscles of the forehead) plays a definite role. Again on
the other hand we know that the feelings of physical fatigue may be
easily dissipated by affects and other influences (Fere's ivresse
motrice) .Therefore we can not make use of fatigue in our theoretical
consideration. On the other hand we must also affirm that in spite of
Fechner we have no means of measuring the intensity of mental
processes. All that we know
at present*about them is reducible to
association mechanisms. Only affectivity and its expressions appear
to us to have intensity and are matters of quantity. But while we
may estimate its strength we can not measure it and do not know at
all upon what it depends. There is as yet therefore no possibility
of establishing such dynamic theories and also little ground for seek-
ing them.^ A better knowledge of the physiological basis of our
mental life will some day certainly bring the dynamic factor into
discussion.
^ s£ ^ >i<

According to many writers ''the feelings are our most

individual and fundamental possession " and they, not the
intellectualpresentations, hold the Ego together. t This
isgoing too far. To our Ego belongs all that we experi-
ence and consciously or unconsciously register, including
the intellectual as well as the affective processes. Among
the former the organic feelings are held with a certain
amount of truth to be pre-eminent as the foundation of our
Ego, even though we are usually not conscious of them.
In this connection it is said that the feelings are devel-

* How premature this dynamic theory is, is plainly seen in the theories which
attempt to explain the differences between ideas and sensations or perceptions.
Many assume tacitly or explicitly a greater intensity of sensation without hav-
ing a shadow of proof. To be consistent we would then also have to assume
that hallucinations differ from ideas by their greater intensity.
^This is naturally something entirely different from saying that our char-
acters and our actions are almost exclusively dominated by affectivity.
 28

oped earlier than the intelligence. This is undoubtedly

true in part, but I believe that we can express it better in
another way. The empty intelligence, the capacity of
combining' the memory pictures of our experiences so as to
correspond to actual experiences, must naturally be al-
ready formed at birth, for the acquisition of a world-pic-
ture depends upon the analogy associations just as does our
logic. What the child lacks, however, is experience. It
has the same power of association as the adult, but on ac-
count of its inadequate experience it has too little material
for association, and too few analogies to afford direction in
any given case.
Affectivity needs no content, no material from without.
Experience only furnishes the occasion for the production
of an affect. Both functions, considered in the abstract,
are therefore developed and ready at birth. But intelli-
gence in order to express itself must collect material through
experience, whereas affectivity needs no foreign material to
immediately express itself in all its complications and
specializations (the sexual sphere naturally excepted.)*
What we ordinarily call highly specialized affectivity, due to
high development of character and to education, etc., is the
affective side of a highly developed and complete intelligence.
Thus we see in children the most complicated emotional
reactions, already present at a time when the content of the
intelligence is ridiculously insignificant. Affectivity directs
the associations in a definite manner at a time when there
is no chance for experience to enter. We see this in the
frequent striking intuitive comprehensions of complicated
situations, and the yet more striking correct reactions to
them. When my little boy of five months first stood on his

own feet he was so proud of it and started around so like a

rooster that both his parents burst into laughter. But this
presently caused him to burst out crying with a distinct
attitude of annoyance. He could not endure the laughter
at his new accomplishment. Any one who was not present
and had not studied the whole reaction of the boy before
and after would naturally have been prone to believe, as I
Even that perhaps not entirely. Comp. Freud j Abhandlungen zur Sexual
Theorie, Wieii, Deuticke, TQ05.
 29

was myself at first, that it was something else and that I had
imagined the pride and anger. But I was as sceptical as
possible in this matter, and daily observation of the child
until he was enough to express himself about his feel-
old
ings admitted of no other conclusion. Some further
examples will make the matter clearer. When he was
eleven months old he desired to be helped up one day as he
sat on the floor. I refused, with the remark that he had wet

the floor then he assumed a determined and superior

;

expression, lifted himself slowly from the floor and looked

'

around with a lordly air that plainly said if you will not'

help me I know how to help nryself." When he was a

little more than a year old, on one occasion, he would
'

not obey, whereupon I said to him, While you are so

'

little, Papa is still master." Thereupon the little fellow,

who could scarcely speak a half dozen words, threw his
head back and rocking his head and trunk back and forth,
as if he were going to bow in an affected manner, he
repeated several times with a scornful, ironical mien "Papa,
Papa, Papa." This was done in a mockingly respectful
tone that no actor could have surpassed, just as if he wanted
to mock me as a boaster. On another occasion he accident-
ally said " Mamma is and as soon as he noticed the
cross,"
mistake he reduced it ad absurdum by designating everyone
present as cross, including himself. When he was thirty-one
months old he did something naught}'', whereupon I told him
he must go into a room and stay alone as punishment.
Without reflexion he at once asked, "is pussy there too?"
In this case the apparent diplomacy with which he knew
how to take the sting out of the punishment was astonishing.
It would certainly be incorrect to seek for some kind of

reasoning or intellectual process behind this. The situa-

tion brought a certain defiance into action, and not wish-
ing to offend me, the affect instinctively brought forward
the corresponding reaction, the correct association.
more complicated is the reaction in the following-
Still

case, which has been described to me by a competent

observer. The little one was about two years old when a
new baby sister arrived. The bedding was displaced on
 30

one occasion by the convulsive coughing of the mother who

gave her husband a sign without speaking of the accident
because she knew the little one was watching her. While
the father set the things in order again, the boy turned his
back to the bed and busied himself with nothing, exactly
like a waiter in the reception room for travelers who has
nothing to do but wait for orders and be on the lookout.
As soon as the clothing was put to rights the bo) again re- r

gained his natural manner. It was as if he had noticed

nothing. Some days later he received a reproof from his
mother because he had wet his clothes. The answer was
— —
" Mamma too Mamma too Mamma cough too." The
latter sentence was repeated several times in the next few
minutes. It is clear that the child at once apprehended
through his feelings and not by means of conscious intelli-
gence, that there was something in the situation to be con-
cealed, something that it would be well not to notice or to
appear to have noticed. He reacted to this situation as well
as an intelligent adult with conscious reasoning powers could
have done. But he had also understood that something had
occurred similar to the occasion when he was laid in a dry
bed, and, as he had been reproved, he could not repress the
excuse that his mother had also done the same thing. He
dared not speak directly of the delicate affair, and so his
instinct used a substitution and named the coughing
instead of the disorder in bed with its cause and accom-
—
panying conditions he struck at the sack and meant the
ass. From an intellectual standpoint it was not exactly
wise, for he told his secret and if he had not been under-
stood his whole defense would have been worthless. But
this proves how small a part that which we call
defect
played in the matter.
intellect
This example shows very well what kind of basis our
common speech has when it talks of " feeling " situations,
in an attempt at expressing the fact that we do not know a
thing but only feel it. In such cases it is the affectivity
that guides the associations. In reality it is not a question
of cognition but simply of an instinctive reaction which
hits the mark. The partly external, but in some respects
also essential resemblance to some of our medical diagnoses
which we make by "feeling" or intuition, as it were, is
obvious, even though in this case unconscious observations
and conclusions are essential, while the affectivitv is more in
the backo-round.

We now come to the question of the relation of instincts

to affects. We
can not exhaust the subject here and a few
references must suffice. There is only one instinct in man
that is in some degree clearly defined, viz. the sexual
:

instinct. All others are hidden b}^ our complicated condi-

tions. The desire for food impels us to a great variety of
actions which accomplish their object in a very indirect
way. Even the thrashings received at school are supposed
tobe useful for us later in the fight for existence. Then
we do not directly acquire food but money which may also
be used for other objects. Moreover, we may live without
concerning ourselves with our instinct for getting food.
The man living on his income, as well as the tramp in the
almhouse, does nothing toward obtaining food, and the in-
sane are often fed artificially against their will, etc. The
sexual instinct, however, appears to be still fairly primitive
and unchanged. Here we see, how, through pleasure in cer-
tain actions, we are voluntarily or involuntarily driven to do
that which insures the preservation of the species. In this
also nature acts in an indirect way. All kinds of flirting,
the choosing of a cravat, or of a ball-dress, all conduce to
the one end, even though Nature's aim therein is usually
unknown and would be violently denied. The essential
feature in this human instinct is therefore that the corre-
lated actions in certain sequences and under certain condi-
tions are associated with a pleasant emotional tone and are
hence sought after. We see the same where the nutrition
impulse is directly satisfied by eating and drinking, and in
the case of the mother nursing the child. The eater
and the nursing mother also have pleasure in the act.
We may suppose that the same conditions exist in the
simple as well as in the complicated instincts of the lower
animals ; indeed when we compare the emotional expres-
sions of animals with onrs, we must perforce assume the
like conditions. The building of a nest, for example, is
doubtless accompanied by an agreeable feeling tone. Nev-
ertheless the instincts have also an component.
intellectual
It does not suffice that certain actions, if carried out, should
appear agreeable. There must also be in the nervous sys-
tem an impelling force to perform the actions. Otherwise
we should only accidentally follow an instinct, as is some-
times the case, to be sure, with the human sexual impulse.

The dominating position of affectivity, as well as its

marked independence of intellectual processes, is best shown
in pathological conditions It seems in this domain to be
.

altogether an elementary attribute of the mind, dominating

the whole picture of the disease, altering the intellect as it

may and suffering least damage in the pathological

require,
processes. In the most severe brain diseases the feelings are
not destroyed on the contrary, their influence upon the
;

damaged intellectual processes is stronger than under

normal conditions.
To be sure the opposite is stated in most text-books of
psychiatry. Krsepelin, for example, says that in senile de-
mentia the feelings are also blunted, that the patient
becomes apathetic and indifferent, that the loss of near
relatives and similar occurrences pass over him without
making a lasting impression, and that the patient becomes
indifferent to his family, his profession, and his favorite
avocation.
This interpretation seems to me to be incorrect, accurate
as are the observations. What we are dealing with is a
secondary disturbance of affectivity. Affectivity as such
ispreserved. As soon as we succeed in making the ideas
mentioned above sufficiently clear to a patient with organic
brain disease, we see the feelings reappear, and the reactions
correspond qualitatively to those of a normal person.
Whenever it is possible for the patient to conceive in some
measure the relation of his profession or of his family
 33

to himself the emotional reaction never fails to appear.

If he compares the present with the past he will generally
moan and weep. If his earlier accomplishments, or the
good circumstances of his family come to the foreground,
we note feelings of pride and contentment. It is the same
with the moral depravity of the senile or general paralytic.
It is not based upon anomaly of the feelings. These patients
indeed commit all sorts of offences against propriety and
property . The defect, however, lies in the intellectual sphere,
and where the feelings come into play their influence on
the flow of thought is even greater than in the normal, and
there is no lack of emotional reaction. Take for example
an old man who has violated children. Ordinarily he
speaks of his offence with indifference and seems to be
blunted in his moral sense. But the fact is that the com-
prehension or the conception of the criminality of his deed
is wanting. Of course the actual remembrance of the
occurrence is not apt to be absent, but in this thought
alone there is no basis for a negative emotional tone. When
an oriental marries an immature maiden and has intercourse
with her he has no scruples and indeed can not understand
why such should exist. In such matters the relation of the
deed to all our social and sexual ideas and customs must be
taken into consideration. Only a more or less conscious
presentation of these numerous associations can give rise to
a negative feeling tone (abhorrence for the act or remorse),
if the sexual feelings as such can be aroused as well by a

child as by a mature woman. That the difference between

a child and a woman is not always made by those suffering
from an organic psychosis must, after all, be due to a
disturbance of the associations, a disorder of the concept in
its widest sense, whereby only one characteristic of the

person is recognized, the femininity and not the youth.

Now if we succeed in making clear to the seemingly
indifferent patient the real nature of his offense, with its sig-
nificance to society and to his unfortunate victim, the feel-
ings of abhorrence and remorse arise in him as they would
have done when he was in a normal condition. The ex-
periment can naturally not be made in all cases but it is
;
 34

generally possible to obtain from such patients affective

reactions to the simpler ethical ideas, and to do this it is only
necessary to bring before the patient the particular idea
concerned, together with all its necessary components. For
example, the affection for the family, which may apparently
be wholly lacking, may often be well demonstrated before
a large audience of students.*
What is pathological in the organic psychoses, so far as
the feelings are concerned, is that they dominate the thoughts
more strongly than in healthy individuals. Their inhibitory
and helping influence on associations is rendered stronger
by the faultiness of intellectual function. In other words,
the senile or general paralytic can ordinarily think of that
only which is correlated with his affect, with his impulse.
When his sexuality is aroused, he sees in the little girl only
the female that can satisfy his desire. Opposing associa-
tions often fail completely, or are limited to the taking
of a few foolish precautionary measures. When a
general paralytic hangs around some object on the ward
which seems to him desirable, and then suddenly hides it
under his clothes in the sight of a dozen witnesses, he gives
no thought to the witnesses, and quite as little to the moral
depravity of the theft. He wanted one thing, and therefore
he took it. But under other circumstances he may detest
a theft, namely, when he can represent to himself the crime
as such. The general paralytic of Kraepelin who jumped
from a third story window to get a cigar stump, thought
only of gaining the valuable object, but not of the danger,
of the height of the fall, etc.

One sees the same thing

in simple association experi-
ments; the associations of such patients are dominated by
affects to a greater degree than under normal conditions.
Another pathological manifestation of affectivity in pa-
diminished durability.
tients with organic brain disease is its
We are wont speak of the "superficiality of their
to
feelings." They may change from one moment to another
if a variety of different ideas can be brought before them.

*Of course we must exclude complications such as mild stuporous conditions

which are not infrequent in organic psychoses, also cerebral pressure from
light apoplexies, etc.
 .

35

It is frequently possible to get a paralytic to laugh, cry, and

laugh again in the same minute. Such patients come to
appear childish, and indeed we speak of second childhood
in the aged.
Therefore affcctivity as such is retained in the organic psy-
choses. The reactions of the emotions are proportionate to the
intellectual reactions. On the other hand they are excited too
easily a?id have little persistence. The blunting of the feelings
is secondary and rests on the fact that concepts can not be
perfectly apprehended, so that no corresponding emotional re-
action can be aroused. Moreover the affectivity dominates the
associations much more than
in normal individuals
Similar conditions are found in alcoholism. It is on the
whole incorrect to say that the feelings of the chronic alco-
holic are dulled. He is on the contrary ruled by his
affectivity. When he treats his family badly, and neglects
his business, there is always a positive cause for it. He has
other interests which so occupy him, and whose accompany-
ing affects so dominate him, that he forgets every other
consideration. In his outbursts of affection, in his moments
of repentance, every ordinary alcoholic shows hundreds of
times that he still has feelings for his family. If he is con-
fined in an asylum he may write his ill-treated wife the
most beautiful heartfelt letters, and shower her with words
of affection. This makes the alcoholic so dangerous. With
real conviction and actual emotion he will make the most
beautiful promises, will manifest the greatest affection, so
that as a rule the wife who has been deceived a hundred
times allows herself to be deceived the hundred and first.
The alcoholic will coram publico break into floods of tears
when frost threatens the crop of a neighbor, while at the
same time he allows his own property to go to ruin, and mal-
treats his wife and children. In company, where only
words and feelings and not deeds are required of him, he
may rightly pass for a man of good instincts and beautiful
enthusiasm, no matter how meanly he may conduct himself
at home with his family. There is no dulling of the feel-
ings in him, but they are too easily excited and too fleeting.
There are lacking in him perseverance, and the power to
 36

resist Temptation overcomes him in the same-

temptation.
way that a before another feeling had dominated
moment
him. That so little good and so much bad is produced by
these changeable feelings is easily explained by the fact
that to accomplish anything good requires persistence and
perseverance, whereas a foolish or a mean thing may be
done quickly. We do not see anything strikingly good in
it when a drinker on his return home in a more or less

cheerful mood is affectionate to his wife, but we naturally

consider his actions in every way reprehensible if a moment
later, excited by some repugnance on her part, he is brutal
to her. Unfortunately he may be credited with virtue by
casual hearers if, at some patriotic banquet he delivers a
deeply-felt address, which however he is wholfy unable to
live up to. The affectivity of the alcoholic is not reduced, but
increased; all the emotions ca?i be aroused in him and more
easily than in a normal individual, but they lack durability.
The alcoholic suffers, as do the organic cases, only from
" emotional incontinence."
A is afforded by the affectivity of
certain contrast to this
the epileptic. Here also, in spite of their notorious egoism,
no affect is wanting which belongs to the normal individual.
So far as there is actual limitation of affects, it is due to
limitation of the associations. The affects are, moreover,
easily called but they have a certain persistence,
forth,
although this is not the persistence needed for productive
occupation, but a persistence which does not let the affect
subside in a natural way (anger or rage, for example).
The affects of the epileptic are not labile in the sense that
they may rapidly replace one another as in organic psychoses
and alcoholism. The perseveration shows itself also in affects.

In idiocy too the affects are not really defective. At any

rate they are possible within very wide limits. Hyper-
emotivity and apathy occur more frequently and in a higher
degree than in normal individuals, but this is not more pro-
nounced than in intelligent psychopaths. And I am not
aware of any positive evidence that defects of individual
emotions, such as moral feeling, are more frequent in idiots
and imbeciles than in intelligent people. But naturally
 6/

idiotscan form no emotions in connection with ideas which

they do not have. This is not a defect of the feelings, but
an intellectual defect, while its influence on the feelings is
not abnormal.
Thus we see affectivity developed and persisting even
w here
T
intelligence, in the narrower sense, is not developed or
is destroyed. It persists as long as the most simple
objective
'
' processes, the sensations and simple cognitions;
in individual cases even longer. Cases of senile dementia
and general paralysis still have decided emotions when
perception and sensation are markedly disordered.
And yet there is a disease in which the suppression of the
-emotions may be said to occupy the foreground of the pic-
ture, viz. dementia praecox. In this disorder the anatomical
changes in the brain are so slight that it has not yet been
possible to define them. The intelligence is not destroyed,
but only suppressed, as is evidenced by certain temporary or
permanent improvements and 'late recoveries. The affect-
' '
'

ivity, however, in the majority of cases, is hopelessly defect-

ive. It is not conceivable that such an elementary function
can be simply blotted out of the brain by a minute pathological
process. Therefore the question is, what has become of the
affects in dementia precox f The question is answerable, and
I hope that the work of my colleague Jung* will in the near
future be so far along as to afford us at least a glimpse of the
mechanisms which remove the affects from our observation.
We shall deal with paranoia only, whose genesis, to many
alienists, is related to abnormal affects, and we shall further
on devote a special chapter to it.

%. ;|c >i< %

What we can not say. But for our purposes

affectivity is
this is only an academical question. It is sufficient for us
to know that intellectual processes, psychopetal and intra-
psychic association-complexes, not only cause the special
respective reactions, but also so dominate the associations of
the entire nervous system, including the vasomotor and
splanchnic nerves, that a general reaction occurs which
-gives support to the special reactions and, apart from ex-

*Dementia Praecox, Halle, Marhold, 1906.

 . t

38

ceptional conditions to which the organism is not adapted,,

contributes to the general advance of the individual.
Nevertheless, there
are certain questions in this con-
nection which should like to touch upon briefly. Is
I

feeling, or aff ectivity in our sense of the term, a property of

sen sory perception ? (Ziehen). Is it contained in sensory
perception? (Wundt). Or is it an independent parallel
process of consciousness? (Kuelpe).
When we understand clearly that the centripetal stimulus
produces both the sensory perception and the feeling, but
that with the same sensor}^ perception the feeling may vary,
it seems as if everything necessary were said; the ques-

tion is evidently one of terms. That is to say, it depends

on whether we wish to include the accompanying feeling in
the concept of sensory perception or not.
I would much rather combine affectivity and volition into

one comprehensive unity, for affectivity is much more

closely connected with desires, instincts, and will, than with
intellectual processes. It is scarcely possible even theoret-
ically to separate the two psychic functions from each other;
it is almost as if affect and desire were one, and as if with

these words we had only theoretically isolated two different

sides of one process.*
Is feeling {affect) the sum of all changes produced by the
intellectual process ? ( Lange)
Possibly, and 1 think very probably. But in relation to
this we must consider not only the physical but also ihe
psychical symptoms, the inhibitions and facilitations.
At any rate the feeling of pleasure and displeasure seems
to me to be the essential feature of the affects, and one might
put the question thus: Is there a special process in the brain
which is the substratum of pleasure and displeasure, or do the
associative, the vasomotor and the secretory inhibitions and
facilitations together make up the feeling of pleasure ?
1
This
question is as yet not answerable.

* I can not believe in an independent will-function nor indeed in a faculty of

aware of simple diseases of will.
volition since pathology is not
t Itwould be remarkable if the latter were not also perceived. It is certain
from Lehmann's investigations that the appreciable physical symptoms of the-
affect come on more slowly than the purely psychical, and that therefore they
can not be essential.
 39

For the time being, therefore, it seems to me a matter of

'

indifference whether we say an intellectual process is the

'

cause of the affect " or "it contains it," just as it may be

'

the same whether we say an affect causes symptoms such

'

as palpitation of the heart " or " palpitation of the heart is

a component of an affect " or "an affect is the sum total of
all symptoms ascribed to it."

The theories that various cell-conditions have to do with

the feelings of pleasure and displeasure (Meynert) I pass
over as being entirely in the air.*
Of greater interest is the question whether the various
affects are differences in degree, or whether they are quali-
tatively different, or, otherwise expressed, whether they are
of one or many dimensions. If they were due to differences
in degree the qualitative difference would have to be sought
in the accompanying intellectual processes. Unfortunately
this question also can not be answered with certainty. In-
deed we do not as yet know whether the simple feelings of
pleasure and displeasure are something quite different from
affects in a narrower sense such as hate, anger, etc. They
might perhaps be partial manifestations of affects which
necesarily accompany them.
To me the feeling caused by the sight of a beautiful pic-
ture and that caused by eating a good beefsteak seem to be
very different. Others have tried to explain complicated
affects as mixed conditions of pleasure and displeasure, but it
does not seem that they have succeeded in proving this view.
We must reject the
conception of Wundt that affects are
three dimensional. "Feelings of tension and relaxation,"
and "of excitation and depression" are pre-eminently
inner cognitions, not feelings in our sense. Tension and
relaxation, excitation and depression, may be part of an
affect,and their cognition may be associated with pleasant-
ness and unpleasantness, as are other intellectual processes.
If there be anything of truth in this dimensional theory it

is insufficiently or not all expressed in Wundt's formulation.

Lipp's three dimension theory seems to me to be even
less well founded.
* Naturally we can also do nothing with the view of Wernicke that the
emotional tone of sensory perception is an affection of the somatopsyche.
{Grundriss der Psvchiatrie: p. 44.)
 .

40

SUGGESTION.
Suggestion seems in certain respects to resemble the
intellectual feelings of Nahlowsky. To believe, to doubt,
to guess, to regard as certain, to convince one's self on
the one hand, and to accept a suggestion on the other
hand, all these express in the same sense the intellectual
reaction of our ego to some idea. And
is a very
yet there
important difference between suggestion and the other pro-
cesses cited. Suggestion goes much further. To believe,
to convince one's self, and all these reactions are not able
produce hallucinations, or
to influence bodily functions, to
to sodominate the logic that the grossest nonsense is
accepted against all evidence. To be sure the supposition
of a danger may produce bodily manifestations, but in an
indirect way through the anxiety which it produces; belief
causes constantly the acceptation of illogical thoughts and
sometimes the appearance of hallucinations, but when this
is the case an affect or suggestion also play a part, and in-
deed belief is scarcely ever free from the action of sugges-
tion (take the case of religion and politics). In such cases
therefore the results which go beyond the intellectual sphere
are not direct consequences of the intellectual feelings.
Suggestion however produces all this directly. It controls
the functions of the glands, of the heart, of the vasomotor
system, of the intestines, it disassociates certain idea-complexes
from those which are contradictory, it shuts out criticism,
rules the senses so that it may and also
readily create illusions,
positiveand negative hallucinations
As we have seen, exactly the same result may be brought
about by the affects. The objective actions of suggestion
are therefore the same as those of the affectivity, but dif-
ferent from those of the intellectual processes.
The kindof action, as far as we know anything of it, is
also the same. We know that the affective accompaniment
of a thought favors the associations which correspond to the
affect but renders others more difficult or inhibits them. In
this way the acceptance of a thought is favored, critical
judgment however is rendered impossible, exactly the same
as in the case of a suggestive idea.
 .

41

If we seek the basis of suggestion we meet similar condi-

tions; we are unable to explain it through intellectual
processes, but on the other hand we note the close relation-
ship with what we find in the action of affects.
Bernheim however derives suggestion from credulity
{c?'edivite) which every one possesses. Very likely this plays
a certain, not unimportant role in intellectual suggestions,
particularly those communicated by speech, which are the
most frequent among human beings. But the power of
suggestion is not to be explained on this basis.*
Let us take an ordinary case. A mother tells her child
that "the porridge is hot"; the child has already gained an
'

idea of but in spite of the warning he tries to eat

' hot,
'
'

the porridge and burns his mouth. In a million cases that

which is said to him will be verified by his own experience.
The child must therefore by analogy learn to regard what
his parents, his teacher, tell him as, in the main, correct even
when individual experiences are lacking. This kind of
belief or credulity is a peculiarity of all men and is a con-
ditio sine qua non for any educability.
one regards only the intellectual processes, such an
If
action of credulity may be conceived as a suggestion:
one accepts something as the truth without proof or
examination simply on the assurance of some other
person

* Wewill omit a criticism of the numerous theories and explanations of sug-

gestion, but refer only to one of the newest, that of Stern. According to Stern
(Psychologie der Aussage, 1, 336) (passive) suggestion is a simple mental attitude
(Stellungnahme). This conception is insufficient because the same maybe said of
.anordinary belief. If I, with Stern, say, "here is a table" and the hearer believes
that a table stands here although in reality none does, this is not yet sugges-
tion; if the possibility of control is excluded it is simply a question of belief-
If the hearer can see the place where the suggested table should stand then he
must either reject the suggestion or hallucinate a table. The belief in these
cases is entirely a subordinate matter, the essential thing is the hallucination, a
much more profound interference. Again, if Stern designates suggestion as an
" imitation of mental attitude " (Stellimgnalime), he includes too much in the
idea; for all belief is such an imitation. Nevertheless it is interesting that
Stern with the idea of imitation or as he has more accurately expressed it with
the "assumption of the mental attitude of another with the appearance of our
own attitude " comes very near our own conception. Quite useless are such
theories as that of Lipps, (Zeitsclirift fur Hypnotismus, jSqy p. 94 ,ff) which
takes only the extremes into consideration, or the similar one of Hellpach
(Psychologie der Hysterie, p. sod) which assumes as the criterion of all psychical
consequences, which can be called suggestion, their senselessness and ex-
aggerated character.
 42

I would prefer not to extend the conception of suggestion

so far.
When the parents in the same tone say something to the
child that his perceptions or (later) his logical under-
standing contradicts, it is no longer believed; perception
and logic hold their own in spite of the assertion. Just as
little can simple credulity influence the movements of the

heart or intestines or the glandular secretion; or, in the

psychical sphere, dissociate a part of the personality and
make it independent, as it were. The influence of credulity
is therefore not so far-reaching as that of suggestion.
The we see most clearly in simple
peculiarity of the latter
conditions. Among animals living together suggestion
all

plays a great role. If one of a herd is attacked, the dan-

ger threatens all the others, or at least it would be better for
them to take part in defense or flight. If food is to be
found somewhere it is well if the whole herd know of it.
Therefore the individual animals show their affect as soon
as they scent danger or food. Immediately the same affect
with the same expression and with the same movements of
defense, flight or acceptance is communicated to the whole
herd so far as they can perceive through their senses the
affect of their companions.
In this there need be absolutely no intellectual content
present; what is suggested is only the affect, the anxiety,
the desire to fight, the pleasure of the chase.* In higher
animals we must also assume that the place and kind
of danger or booty is communicated at the same time. But
* In the case of man it is presupposed that the suggestor can suggest an affect
which he himself does not have. But one can not compare the complicated ex-
perimental conditions with the natural functions of the mind and can only
cautiously draw conclusions from one to the other. Speech and artificial train-
ing allow the use of means, of which there can be no question in the case of
animals under natural conditions. We must always rememberthat the sugges-
tion of an affect to a person who is not trained to absolute obedience can
scarcely succeed if the suggestor does not, in his tone at least, simulate some-
thing of the affect. It is just as little possible to suggest sleep by giving the
words in a merry tone; one must either speak monotonously or commandingly.
In the suggestions which move the world the affects of the suggestors and of
the suggested are moving elements. There are also conditions in men and
animals in which one affect in one person calls out the opposing affect in another
without our having to assume an intellectual process with a secondary affect.
The anxiety of the opponent awakens the courage of the aggressor, and vice
versa. We have no reason to think that in such cases another mechanism comes,
into action.
 43

the essential thing can only be the transmission of the

affect; the communication of the content, the intellectual
part, must play a secondary r6le. This we see in the dog,
for example, an animal which has retained very little of the
herd instinct but which is very accessible for suggestion
from other dogs. The barking of one awakens similar, i. e. ,

affectively similar, barking in the whole neighorhood; and

yet we stand near enough to those highly developed com-
panions of man to be able, from our observations, to
conclude that they can make no accurate communication in
that way. We find suggestion in animals only in the case
of affects or occurrences associated with affects and we
have good grounds for concluding that the animals, the
highest classes of certain genera perhaps excepted, com-
municate only occurrences associated with affects, or we
might say, in reality, only affects.* The communication
or the description of the cause of the affect, in other words
of the intellectual part, is probably as a rule unnecessary, at
any rate of less importance. (Sometimes it is implicitly
contained in the original expression of the affects, that is the
direction of flight or the movement of attack).
After the foregoing the purpose of suggestibility does not
especially need to be further detailed. It causes the whole

community to be ruled at the same time by the same affect. It

causes the necessary unity of action. It suppresses all other
endeavors of single individuals so that the energy of the
actions is increased. It gives greater perseverance to the
affect and then to the efforts which we make because the

* That animals communicate experiences to each other which have no

affectivemeaning for them will be maintained by no one, indeed it scarcely
occurs among men. Our complicated relations conceal the affect component
which depends on some distant association, e. g., the teacher instills grammar
into his students because his living depends on it he serves his nutrition-
;

instinct with its affects. The

description of a flower is given on account of its
botanical interest, etc. Many call the blind following of the sheep by the
other sheep suggestion it might appear that we are dealing in that case essen-
;

tially with an intellectual suggestion, for we see nothing of affect in it. But
we do not know the instinct which causes this behavior. Occasionally they fol-
low some passer-by for hours and can not be driven back by blows. Kittens
sometimes also show the same phenomenon. Chicks who have just hatched
follow not only the brood hen but also the first moving object or being which
they meet. These analogies make it very probable that following the leader
in the case of the sheep has little or nothing to do with suggestion in contradis-
tinction to what we find in man.
 .

44

individual whose efforts threaten to weaken is again turned

to the original task and, on his part, he then strengthens

others in the general affects.
Therefore suggestion insures unity and continuity of the
affects and actions of a community by pushing all in a cer-
tain direction and suppressing opposing efforts. While the
affect promotes in the individual all like efforts and associa-
tions, strengthens and prolongs them, suggestion does
exactly the same for the herd. It takes care of the collective-
affecf* and thereby of the iinity of effort and action. We may add
that in man the relation of individuals among one another
is determined, in the first place, by the affectivity, even if

we leave out of consideration what we

sympathy and
call
antipathy. One can see this in exaggerated form and in
caricature, and therefore all the more strikingly, in the in-
sane. With the idiots we deal much as would a father with
his child and we are in continual affective relations with
them. Alcoholics, general paralytics, manic patients find
an affective response with us, not always it is true in a posi-
tive sense, but we understand their feelings and may act on
them. With the hebephrenic who intellectually often stands
much nearer to us than the other dements, we find no affec-
tive rapport. We feel towards him like strangers, very much
as towards a bird which we pet and which allows us to care
for it but never allows the intimacy which we quickly reach,
for example, in our relation to the dog. The inhibited and
falsified affect-expressions of the hebephrenic place an in-
surmountable barrier between us and these patients, while
all the intellectual derangements of the other groups do not

render them so foreign to us.

From this outline it follows:
1 Under simple circumstances affects only are suggested.
2. Suggestion has exactly the same purpose for the com-
munity as the affects for the individual.
3. Animals suggest almost only affects. Suggestion in
which the intellectual content plays an essential role occurs
only in man, and even here is not frequent.
* I this collective-affect as only the sum of similar affects of the
would define
individuals. Psychological units which extend to several individuals, such as a
•collective consciousness, a collective will, does not exist in this sense.
 .

45

And at the beginning we established:

4. The is shown in the same ways.
action of suggestion
and under the same circumstances as those of affects,
whether the suggestion be an intellectual or an affective one.
One may conclude from these facts that suggestibility
can not be separated from affectivity. One conception must
comprehend both, and we may best call it affectivity.
Hence we can express our knowledge thus:
Suggestion is an affective process: Suggestibility is a part
of affectivity
Thus we see that suggestibility, in the original affective
form, as well as affectivity in the narrower sense, is active
long before the intelligence is. The infant very early under-
stands the affect-expressions of the mother; the affect of the
infant not only influences the mother, but suggestion very
distinctly acts in a reverse way. If the mother smiles at
him the child is also disposed to smile, all the expressions of
affection not only make an agreeable impression on him but
they influence his mood in the same sense. Reproofs, even
when they any louder than the pet names,
are not spoken
so as to exclude any shock, affect him in the opposite way.*
This seems self-evident; but it might be otherwise.
Even in the infant therefore, perceptions of affect-expres-
same affect. The child has not
sions cause a similar or the
only an innate understanding but also an innate resonance
for affect expressions. The affect is transferred to the child
even in cases in which we can not imagine any intellectual
content.
With older children it is well known that the play of others
as well as their anxiety or weeping is "contagious," etc.
With adults also we can recognize the same thing in all the
complications of a civilized life. Therefore the suggestive
transference offeelings is a matter of common observation.

* My five months old child reacts to reproofs spoken in a low tone with wrink-

ling of the forehead and finally by weeping. When I reprove his elder brother or
when the latter cries from pain or anger, he also begins to weep. With expres-
sions of joy or simple play which are as loud or even louder he remains entirely
quiet or rejoices also. The falsified affect-expressions of a hebephrenic who is
in my family have been from all time without effect on my now two and a half
year old boy. Heregarded her interjections as a natural phenomenon, not as an
affect expression. They found in him no response, in striking comparison to-
the affect expression of normal individuals.
 "

46

While, generally expressed, suggestibility is one side of

the affectivity, we also see in special instances that it in-
creases proportion ately to the strength of the existing affect.
A'igouroux and Juquelier* express this general rule in the
words '
'the greater the feeling value of an idea, the more is

it contagious.
Though this rule may appear self-evident, it is not always
so at the first glance. An affect can naturally render the
acceptance of a suggestion difficult as well as easy, accord-
ing to its direction. The process of rendering a suggestion
difficult to accept is also a result of suggestion. We can
designate it as a negative suggestion, or as has been done
in the case of hysteria as a counter suggestion. The mech-
anism is exactly the same whether it acts in a positive or
negative direction. From an unsympathetic person we ac-
cept suggestions with difficult}' while one is only too easily
-

influenced by those of a beloved person. Or we receive

evil suggestions about a person whom we detest readily,
while we reject calumnies about a beloved person."
Although it iseasily understood that one who is perfectly
indifferent to hypnotism and to the hypnotizer can not be

*La contagion merit ale, Ref. Centralbl. fur Neurol, und Psychiat. iqoj,p. ijo.
It would be very interesting to investigate the emotional value and suggestive
strength of different ideas which have been active in civilization and especially
in politics. An example taken from the environment of the writer would be the
comparison of the politics of the people of Berne and those of Zurich in Switzer-
land. In Berne the idea of the state, which is closely connected with the instinct
of self-preservation, has remained dominant through the centuries and now, fifty
years after the foundation of the new confederation, it is still active. In Zurich
there are many and far reaching ideas which individually have accomplished
much but never anything which has remained unchanged in the course of time,
and when the new confederation was founded, Zurich felt that it was only a
part of the whole.
t An apparent exception is that of the promptings which cause jealousy. One
may say that jealousy is itself an affect which favors the corresponding
suggestion. It would, however, have no reason for existence if an experi-
ence or an accepted gossip did not first produce it. Therefore, although
it is the cause for the acceptance of many suggestions it is nevertheless
only the consequence of an intellectual process. This in many instances depends
upon suggestions the acceptance of which is in direct opposition to love and re-
gard. Consequently the affect which causes the jealousy must in many cases
be very different from the jealousy itself. Observation of jealousv in normal
and pathological conditions shows that different kinds of affects may be con-
cerned. Sometimes it is unsatisfied love, especially in women. Most frequently it
is a feeling of guilt which prompts the person more or less consciously to con-
cede a certain right to adultery to the other. Hence the frequently observed
fact that those men who allow themselves many liberties in a sexual way, guard
their wives the most jealously.
 47

hypnotized, yet the conditions caused by fear of hypnosis are

extremely complicated. To be sure hypnosis is impossible
in the majority of such cases; an affect does exist, fear, but
itacts in a direction contrary to that desired. Fear may,
under certain conditions, favor hypnotism in an indirect
way. Things which cause the fear remain in the foreground
of the interest and inhibit other thoughts, especially when a
feeling of impotence comes in. Thus the idea of the thing
feared can dominate the subject and drive him towards the
very thing which he fears. This is an everyday occurrence
which needs no further proof, e. g., the squirrels with the
rattle-snake. Further, with fear is very often connected
the idea of domination which accompanied by strong
is

feelings. Such affects, which unfortunately have no name,

play a great part in many suggestions.*
When, sake of experiment we hypnotize a man and
for the
suggest to him that he will now see a flower or a mouse, or
that after waking he will put a chair on his head as a hat,
it is not easy to see the affect which lies at the bottom.

The single suggestion naturally does not correspond in such

cases to the underlying affect; the latter causes only the
acceptance of the suggestion under the given condition.
And what kind of an affect is that? Unfortunately we
have no name for it, but no one will doubt that a strong

* In the Neurological-Psychiatrical Society in Zurich where I mentioned my

conception of suggestion, von Monokow reminded me that there were also imi-
tations or suggestions in the present day sense without affects. It happens that
when some one makes a cross another consciously or half consciously imitates
him. This objection showed me a gap in my reasoning. I do not believe how-
ever that this occurrence says anything to the contrary of our view. The imita-
tion which appears without affect has not the influence on our pbj'siological func-
tions, or on ourlthoughts that true suggestion has. It is therefore different from
the latter. Further every idea has a motor component; the imitation therefore
is nothing extraordinary. The striking thing can only lie in the acceptance of
the idea of making a cross. One most easily receives motor ideas by the sight
of some action. But this does not justify us in classifying the imitation in this
case as a suggestion. But why are many things imitated, others not? The
choice as far as I can observe is always an affective one; that which harmonizes
with our mood or has some relation to it is reproduced, other things are not
(Compare Freud's mechanisms). It must not be forgotten that there exists also
an instinct of imitation which, for example, in the mental development of chil-
dren, plays a great part. All instincts are connected with affects or come from,
affects. Imitations without any affects are scarcely ever incoutestably proven.
Therefore, as far as we know, the mechanisms which come into consideration
agree easily with our conception. The relations are, however, so complicated
that a definite judgment about all details is not possible.
 -

48

affect underlies the feeling- of being dominated or the feel-

ing of authority. This affect can, on the one hand, be
gradually traced by imperceptible steps (in the majority of
men men) to the affect which causes
in relation to other
fright palsy on the other hand, especially in women, in
;

their relations to men, to a sort of love, inasmuch as here

the feeling of being dominated has a certain sweetness,
which is difficult for a man to understand. Both kinds of
conditions are comprehended in the term fascination, the
affective meaning of which is, to be sure, not yet clear.*
The intellectual as well as the affective feeling of sub-
ordination naturally plays a great role in the well known
hyper-suggestibility of soldiers (Bernheim and others).
Here the influence of habit and training comes into
considerationas an important factor. We know that
suggestibility may in a certain sense be increased by train-
ing, just as we see that the affects are more easily liberated
by repetition. By means of practice we
more capable
are
of enjoyment, in the field of art and natural beauty, for
example, even when the intellectual comprehension makes
no real progress. Later the different influences, which we
call collectively blunting, exert their inhibiting effect. In
the same way suggestibility decreases after a short time
when the suggestor has not resources enough or, as in the
case of a medical suggestion, occupies himself always with
the same narrow theme, in short if he is unable to keep the
interest,i. e. the affectivity, alive.

In the increase of suggestibility by habit there is another

factor which must not be forgotten, the simple association
through practice, a more intellectual process. For example,
a horse is always, in a certain part of the road, made to trot.
From now on he needs no more urging; as soon as the-
animal comes near the place he begins spontaneously to trot.
Every German with any education at all will associate
with " Fest gemauert in der Ei'den," " steht die Form aus
Lehm gebrannt." These are purely intellectual processes
and lead finally to automatisms. In the same way the
practice of suggestion must lead to facilitation of the

* Vogt ignored this affect when he required that the hypnotic suggestion must'

be without affect.
 49

process and finally to automatism. Naturally this does not

conflict with our views of the affective nature of suggestion
but it furnishes an excellent sample of how complicated
our mental processes are.
It is easily understood that in the great spheres of relig-
ious and political convictions the affects play a great part,
yet they often act so indirectly that it may not be out of
place to devote a little space to them.
First, do suggestions here play a part? Certainly; from
among many reasons we will, however, only mention the
following: None of the creeds comprehends the majority of
mankind. If any creed be right the majority must necessar-
ily be wrong. It is, however, very probable that no creed

is right. That alone shows that logic has little to do with

faith.- And as a matter of fact political and religious creeds
are only in exceptional instances determined by the force
of logic, but usually by the faith of the environment, and
this in spite of the fact that, in political questions at any
rate, there are enough data which would permit any educated
person to form a fairly objective judgment. While in the
field of religion we find that the dogmas often enough con-
tradict the simplest logic so that one would think they
should arouse one's critical sense.
There are many affective factors which give to religious
and political influences the irresistible force of suggestion.
Here I will only mention their connection with the love for
one's parents, with many memories of childhood which have
a strong emotional component, with the most important
events in life, and last, but not least, with the care for
existence in this world and for salvation in the world to
come. What strong affects may originate at a holy
shrine where miracles occur can be imagined by any
one who tries to render these conditions clear to himself.
Thus it happens that more battles are fought for such
matters, which are questionable from a logical point
of view but which have a great affective value, than
for anything else; and that persons who are otherwise of an
unblemished reputation may in party strife use rather
questionable means. The affect, the suggestion, inhibits
 50

here, as elsewhere in life, the opposing associations, the

comprehension of the right of other views, the sense of the
dubious character of the chosen means of combat.

The role that affectivity plays in auto-suggestion is clear.

This isaroused only by the influence of strong affects. It
is as yet toolittle observed in healthy individuals because

it is much more important in the pathological spheres where

it often dominates or even causes disease. Charcot showed
the connection of certain forms of traumatic hysteria with
fright,which, he claimed, produced the same effect as
hypnosis. Since then traumatic neuroses and (functional)
psychoses have been attributed to suggestions or ideas with
a strong emotional value. The example cited above (page
16) of the man injured in a railway accident I could have
presented as proof of the strength of auto-suggestion as well
as of the affectivity.Auto-suggestion as well as suggestion
is nothing more than one side of the well known affect
mechanism.
It is obvious that also in non-pathological conditions^
(anxiety, also pleasurable affects) ideas which correspond
to the feelings are easily accepted without criticism; for
example, one readily interprets every noise into the rolling
of a wagon when he is tired and on a lonely road, and
thirsty people on the desert see water in every indistinct spot
of earth.

The analogy of suggestibility with affectivity is also

observed in the fact that when one turns his attention to the
mechanism of a suggestion, suggestion is rendered difficult.
The similar influence of attention on the feelings is well
known, while intellectual processes are, on the contrary,
assisted by the exertion of the attention.
This is connected with the much misconstrued and yet so
easily verified fact that feelings, as well as suggestion,
develop their greatest action in half-conscious and uncon-
scious processes. A person may joke with his conscious
mind about the power of suggestion and yet in a large
 51

•gathering on the simple assurance of some one develop a

catalepsy of an arm. If we take into consideration only
that which takes place in consciousness we will never be
able to understand suggestion, and just as little will we
understand the important mechanisms which Freud has
pointed out in his studies of hysteria, in dreams, and in
every-day life and which dominate a great part of our
mental life.
>i< %z * >j;

Every observer has noticed that pain-sensations are much

more accessible to suggestion than the other sensations. It
is much easier to suggest analgesia than anesthesia of any

other sense. In hysteria also analgesia is more frequent

and more conspicuous than anesthesia. The difference is
shown even in the reflexes; all those caused by pain and
disagreeable sensations are frequently lacking in this disease,
the others almost never. To the former belong the twitching,
the changes in respiration on painful stimuli, the reflex
closing of the eyelids, the pharyngeal-reflex, etc. We also
see thesame difference in katatonia which makes use of
the same mechanisms as hysteria..
The explanation according to our view is simple. The
ordinary sense-perceptions give us information of certain
conditions of the outer world, without reference to the mean-
ing of them to our ego. We consciously notice only a small
number of the innumerable stimuli which strike our senses,
really only those which stand in connection with our mo-
mentary object. The same music which captivates us in
a concert we may completely exclude when we are writing.
The selection of sensory impressions accords with our inter-
ests; it is determined by the process which we call attention.
It is entirely differentwith pain. Pain turns our attention
into new tracks, forces it to change its direction. It repre-
sents an injury to the continuity of our body and is therefore
a most important occurrence for the higher animals. Ordin-
ary attention is powerless against the diverting power of pain,
our best philosophy does not avail against a toothache."
But there are other important interests for the organism which
under certain conditions cause suppression of pain. In a
 .

fight, in order not to be overcome by one's opponent, one-

must give little thought to wounds. The hungry man must
not consider the trouble of acquisition, in order to gain the
booty. The propagation of the species is more important
than the preservation of the individual. The male dog suf-
fers hunger and mistreatment for many days if he can in.
that way approach a female dog in heat. All these impor-
tant acts are accompanied by lively affects, the strongest
affects corresponding to the most important object. Pain,
therefore, can only be dissociated by ideas with a strong
feeling-tone, or, if we take account only of the latter, by
feelings and affects. Hence pain can also be suppressed by
any affect; in battle the soldier does not notice that his arm
has been shot off; in anxiety one sacrifices something of the
continuity of one's body; vanity makes cosmetic operations
more or less painless.
Naturally we can not say that in every given case the sen-
sory perceptions are turned to something else by the atten-
tion, or that thepain sensation is inhibited by another affect.
Everything psychical is too complicated to be expressed by
such a simple formula. We must not forget that attention
is itself determined by the feelings, and the feelings them-

selves may be deflected from an important perception and

suppressed, etc.; in short, the two kinds of influences are
never entirely pure and separate from each other.
Nevertheless we may conclude that if the pain perception
can be directly inhibited by feelings, it must also be possible
to directly influence it by suggestion, while the sensory per-
ceptions are only dissociated in an indirect manner, and
therefore with more difficulty. Perhaps it is also of impor-
tance that by the testing of analgesia and anesthesia the
attention, which favors the sensory perception, is excited
and is a counter-weight against the suggestion of anesthesia,
while the pain sensation is much more independent of the
attention.
The readiness with which pain is influenced by suggestion
illustrates therefore very prettily our view of the close rela-

tion of suggestion and affectivity

 53

There are conditions which, in spite of the excited af-

in
fectivity, suggestibility may
be suppressed b} other factors. r

Judgment is an important counterpoise which, to be sure,

may, even in intelligent persons, and in those with strong-
characters, be dissociated, although this is rare. If the
judgment is inaccessible in consequence of a lack of associ-
ations, whether this be due to a narrow experience or to
stupidity, suggestibility is increased. Thus the grade of sug-
among other things, a (negative function of
;gestibilit3T is, )

the power of criticism, which naturally does not contradict

the view of its affective origin.
We
have a high degree of credulity, and every idea,
whatever its origin, every request from without, every
order (this also as a result of education) tends to force us
through the mechanism of suggestion to the corresponding-
action. Therefore judgment would easily come too late
were it not for the fact that suggestion has an automatically
acting counterpoise at its side, a primary tendency to turn
aside influences from without. This mechanism,* to which
as yet little attention has been paid, together with the posi-
tive forces (including suggestion), regulates our actions as
antagonist and agonist, and is one of the roots of patholog-
ical negativism as well as the basis of contrary suggestion
which plays such a great role in the symptomatology of hys-
teria and other diseases.
It is in we see this warding off
suggestible people that
mechanism mostly developed and active in the most unsuit-
able conditions. Children and hystericals, for example, are
generally, under certain conditions, and each in his own
way, markedly obstinate and headstrong. This may re-
present in part a protective mechanism but in another be
analogous to emotional expression of an espe-
lability, the
around the position of equilibrium.
cially strong oscillation
Since the equilibrium here as in many other places is main-
tained by two antagonistic forces, we may also consider the
condition of increased suggestibility associated with the
increased inclination to negation as a separation of the yet

* More fully described in" Ein psychologisches Prototyp des Negativismus."

'.Psychiatr. Neurolog. Wochenschrift, 1904-1905.
 54

unknown fundamental property into its (negative and pos-

itive) ions.*
In order to fully illustrate the connection between sug-
gestibility and affectivity, we should be able to prove what
kind of emotional makeup, what "temperament" is most
favorable for suggestion. Unfortunately we can not do this.
Most of the preliminary conditions for such an investiga-
tion are lacking. Suggestibility, as intelligence, is not a
uniform quality; in certain directions a man is strongly
suggestible, in others not at all or very little. t It is im-
possible or very difficult to divide mankind according to their
suggestibility, even when we have good cause to designate
certain persons as very suggestible and others as little sug-
gestible. We are even at a greater disadvantage when we try
to classify the affects or the different types of the emotional
makeup. Here we know only a few mainlines, e.g., the type
which in excess leads to mania and that which
of affectivity
leads to melancholia, and we know these only very super-
ficially. There are probably sides of the emotional life which
we divine more than we know, yet which probably play
an important role. I would refer to the types mentioned
and add that many people have a tendency to suppress their
disagreeable affects, z. <?., as far as possible separate them
from their personality, while others perfectly amalgamate
them with their actual personality but they seem at different
times to be different personalities; the one dissociates, as
it were, the affects from his personality, the other dissociates

his personality according to the different affects. To me

it is probable that the former are, other things being equal,
little suggestible while the latter class is accessible in a
high degree either to suggestion or auto-suggestion or
both.
Furthermore we know that children with their lively
affectivity (and undeveloped power of criticism) are very
suggestible. In manic patients with the same temperament
"
* Freud notes in his Dvei Abhandlungen zur Sexualtlieorie'" a similar con-
dition in sexuality which is regulated by a positive force and a negative inhibi-
tion. To the strong positive sexual force there corresponds a strong inclination
to inhibition. (Anxiety, etc.)
+ An energetic officer or business man with strong convictions may be under

the thumb (suggestion) of his wife, his mistress or indeed of his servants.
 55

we see similar conditions. We know that the affects in

melancholia inhibit the associations and the suggestions in
all directions which are contrary to the inner feeling' but

assist those in harmony with it, (religiously indifferent

melancholies in a religious atmosphere also acquire re-
ligious fears). With general paralytics, suggestibility as
well as the affectivity, is increased and is further increased
by the loss of the critical faculties.In dementia praecox
we do not know as yet what kind of feeling-derangement is
present. In paranoia (Kraepelin's) we have a mixture of
facilitated and inhibited suggestibility. In the traumatic
neuroses and psychoses, fright and different apprehensions
cause the symptoms by suggestion and auto-suggestion.
But this is as far as we can go even here. In the suggestion-
disease par excellence, hysteria, we know little of that
which we should know to look upon suggestibility and
affectivity from the same point of view. Nevertheless it is

certain that in hysteria the affects play a great role so that

one may refer the hysterical derangement as well to the dis-
sociating action of the feelings as to the so-called auto-
suggestion, for auto-suggestion and affect-action here appear
identical .

Even leaving out of consideration the mental diseases,

the momentary disposition plays a very great role in suggesti-
bility. The inhibitions and facilitations may be intellec-
tual but generally they are affective. Bodily diseases too,
with their action on the affectivity, of course, influence
suggestibility (vide the persons who influence invalids into
making Exhaustion as is well known
wills in their favor) .

causes the same thing. Here

is an example: A very in-
telligent and especially impartial and objective head-nurse
returned in an exhausted condition from a journey. A
nurse met her and informed her in an excited and dis-
approving tone that a certain nurse had been made assistant
head-nurse. Like the nurse, she thought that the choice
was a misfortune for the institution and an injustice to
another aspirant to the place. She had completely for-
gotten that she had previously approved of the choice and
could not take into consideration the fact that the nurse
 56

had only accepted the position after the other candidate

had taken it and had resigned. For years the head-nurse
could not resume an objective attitude towards her new-
assistant, and although, from time to time, she admitted
that I had acted entirely in accordance with our agreement
she never could quite forgive me. Grounds for jealous}^
were entirely lacking in this case. (In contradistinction to
what happens in paranoia, the delusion has not broadened
out).
>!< >;< >'fi ;;<

The matter becomes more interesting when we leave the

suggestion of the individual and take up mass-suggestion,
although here too we have nothing complete to offer, for
the psychology of mass-suggestion, in spite of several
attempts, remains yet unwritten.
Individual suggestion, especially as far as it has intel-
lectual content, is a miserable artificial product which
outside of human conditions has little influence.
Suggestion with a larger complex of individuals is very
different. Here it corresponds to its original aim, the
shaping of a strong collective-affect and develops also its
elementary power for good as well as for evil.

A mass in itself inspires strong feelings, even an in-

great
animate mass such as the pyramids, Mont Blanc, the sea; but
not so much as an animate. Scarcely any one can deny
the imposing impression of a great unified mass of men.
The enthusiasm for the army would certainly be much less
if one always saw only individual soldiers. The oath of an
individual can at most through especial accompanying cir-
cumstances be awe-inspiring, while the oaths of 14,000
citizens of the Landsgemeinde in Appenzell-Ausserrhoden
is in itself one of the most stirring spectacles which one

can see.
Mass action, especially when the suggested individual
forms a part of the mass, causes a strengthening through
the bare number of suggestors, which must act mannerin a
similar to the frequent repetition of an assertion. At the
same time, to a view which is shared by many, more cre-
dence is ariven instinctivelyand with a certain right than to
one which only a single person believes. Again, the indi-
vidual who is a part of such a human complex perceives
on all sides sensory perceptions which support suggestion,
while those that invite criticism are entirely lacking or are
present in unimportant numbers.
The feeling of the power, even of the irresistibleness, of
a large number an important factor, and especially
is also
the fact that many which would naturally tend
inhibitions
to counteract the power of suggestion are removed, such as
embarrassment of the individual who so rarely has a desire
to act differently from the environment. The same feeling
of being different from the rest which in the individual
hinders suggestibility forces the masses, influenced in the
same sense, to an acceptance of the suggestion. The
diminution or the removal of the feeling of accountability
for acts and thoughts diminishes further the ethical and in-
tellectual inhibition, the regard for others, as well as the
personal judgment.
Thus a collection of individuals has another, in many
respects a much lower, type of ethical standards than the in-
dividual. One can see indications of this even in small
committees, but for larger bodies the old proverb Senatores
boni vivi, is always more or less
senatus auteni mala bestia
applicable. That the ethical standards of parties, and of
States does not come up to even modest requirements of the
individual is apparent to every one. The latter also has
another reason: ethics regulates the behavior of the indi-
vidual in regard to his actions in the community of which
he is a part and by which he is protected. The relation of
individual countries to others is a much looser one, and
it is therefore lamentable but explicable that the finer ethical
considerations play a relatively small part in international,
or, for that matter, in national politics. From a utilitarian
standpoint, which at the same time represents the phylo-
genetic point of view, ethics is not so necessary in a
collection of individuals as with a single individual. The
bad consequences of a wrong act, (punishments!) are for
the culprits generally much less or can not include all the
participants.
 58

The number of such factors to which a strengthening

influence of masses on suggestion must be ascribed might
be increased. The essential thing, however, will be the de-
velopment of suggestion from conditions of a large unit of
individuals, or, the phylogenetic adaptation of the function
to the mass. Thus it is easily understood that a commu-
nity not only thinks and feels uniformly, but that it can be
much more easily led by an individual than a single person,
as soon as this individual has found an affective assonance
in a great number of the individual members of the com-
munity.*
Thus a comparatively poor teacher, even an inexpe-
rienced kindergarten teacher, can control fifty children com-
paratively easily while the parents, even if the3^ are capable,
may have trouble in directing one of them.

If we glance over the action of suggestion as it is described

in books on r^pnotism we can compare it step by step with
affectivity.
In the sensory sphere we daily see the dissociation of
perceptions by the affects. One overlooks during an affect,
many occurrences, even severe injuries to the body but in
both cases the anesthesia is a systematic one not limited to
a definite sense organ. We suggest anesthesias of all the
senses. On the other hand the affects allow us to utilize
occasional perceptions which otherwise we would not
perceive because they are too weak, i. e., suggestion may
cause hyperasthesia. The affects as well as suggestion
cause illusions and hallucinations.
The motility is influenced by affect and suggestion in
the same way, paralyses and cataleptoid conditions on the
one hand and extraordinary muscular power on the other
are engendered by anxiety as well as in hypnotic exper-
iments. Both functions also dominate the involuntary
musculature, the blood vessels, intestines, bladder, etc.
Affects and suggestions dominate the actions of all of our

* A preacher likened the religious edification of an individual as compared to

that of a crowd to the burning- of a single stick compared with the powerful
lire of a heap of sticks. The picture is very good and is suitable to other than
religious suggestion.
 .

59

vegetative organs, the heart, lungs, vessels, glands, men-

struation and many other functions. The influences on
metabolism and sleep also must not be forgotten.
They influence our memory; we forget or transform what
is disagreeable and keep more vivid what is agreeable. We

find memory-illusions in normal individuals as soon as

affects come into consideration; they are more frequent,
however, in the insane whose inner life is dominated by
strong affects, and we produce them very easily by suggestion
Our whole logic is controlled by affects in exactly the
same way as by suggestion both render criticism difficult
;

or impossible.
The affects change our personalities. In many respects
we act differently in sorrow than we do in joy, and by sug-
gestion we can also modify the character of a person.
In the domain of pathology we can not separate the
actions of the affects from that which is correctly called
auto-suggestion. Whether an hysterical is delirious because
she dissociates the pain caused by the loss of her husband
with all that is associated therewith or because she makes the
auto-suggestion that he is not dead is irrelevant. It is only
same
a different term for the process. The wish-dreams of
normal individuals and the wish-deliria of the insane are
nothing but the consequences of auto-suggestion; they may,
however, also be described as actions of the affects which in
sleep and in delirious conditions dominate the associations.*
Attention, whether it is conscious or unconscious, is con-
trolled by "interest" and other affects. We control it,
however, just as well by suggestion. We dissipate it in a
hypnotized person who is in rapport only with his hypno-
tizer in exactly the same way as it is in the case of the
savant who, busied with some problem, does not notice the
storming of his house.
The suggestions a echeance are also referable to attention.
If we set ourselves to do something at a certain time or at
the occurrence of a certain event the attention is consciously
or unconsciously focused on this event, or on this time. At

* Compare Binswanger, Hysteria, p. 78. "At least a perception associated

with a strong affect will have to be accorded the same value as the traumatic
suggestions which are often hypothetical."
 '

60

the same time, however, the event is associated with the act
to be performed.
Associations and inhibitions are therefore put in readiness
for impressions which are expected in exactly the same
way as the attention does it for actual as well as for future
experiences. That the attention is directed by the affect-
ivity has already been mentioned and is perfectly obvious.
The suggestions a echeancc therefore need no further explan-
ation.
Perhaps it is necessary to add, however, that, as every-
where in psychological matters, different ways lead to the
same end and that practically the result is never influenced
b>y one mechanism only. One therefore finds many other
influences acting with suggestion.
The latter may be elucidated by an analysis of the action
of the suggestive questions.
Stern in his "Psychologic der Aussagc," asks how the
suggestive questions act and has "explained" it as being
the imitation of the mental attitude of another. But why
imitated in one case and not in another? That is, why does
not every suggestive-question act in a suggestive manner.
Simply because in one case an affect is present, in the other
case not. What kind of affects come into play can not be
generally stated. They are the different affects which the
child has before his teacher, or the witness has before the
judge and the whole situation of the trial.
But other things come in. By the tone and form of the
question the answer can be suggested. It is unpleasant to

have a different opinion not only from that of one's superior

but of anyone else, and we instinctively avoid the disagree-
able. Thus the questioner leads the associations in the
intimated direction. The simple credulity which we differ-

entiated from suggestion may also play a great part.

Further, the refusal of the insinuations which lie in the
question requires a certain independence of character and
imagination which is not at the disposal of everyone. In
order to answer the question whether a dress was blue or
' '

yellow by saying it was neither blue nor yellow but red

'

requires an independence of mind of which many men are

 61

not capable, while if the indifferent question were asked,

"'what color was the dress?" the same men would have
'

perhaps answered quite correctly, red (Stern ) The sug-

'
'
' .

gestive question presents a definite set of ideas. This is of

importance, partly in a direct way, because the person
questioned feels more or less forced to operate with the
material offered to him, partly indirectly "because owing
to the natural inertia he hesitates from voluntarily amplify-
ing the whole procedure of question and answer." This is
'

the case in the question, what colored dress did the woman
'

wear? " when it was not yet determined whether a woman

was present or not.
Of course the number of co-operating motives is not
exhausted by these allusions. Stern also emphasizes the
importance of the tone of the question. 'The strongest
suggestive question can, if asked in an uncertain timid
voice, lose every suggestive force; the most harmless
question asked in an impressive tone accompanied by a
fiercelook and repeated with ever-increasing loudness of
voice may become a mental torture which brings forth any
desired answer." We must also remember that we have
all
an instinctive feeling of compulsion to react to any
question, or to anything which is said to us. One can
conceive this quality to be similar or identical with sug-
gestion; in both cases it is a matter of an emotional and
intellectual rapport between two individuals, yet it is not
entirely the same, whether the primary individual provokes
in another simply his own convictions and his own feelings
or whether he calls forth a complement of his feelings or
thoughts.
* * # *

When we attempt to explain the phenomena of suggestion

we dare not entirely ignore hypnotism, although this com-
prises only a small part of that which we designate by the
name suggestion.
Here we have first to state that there is not one hypnosis
but a whole mass of conditions to which we give this name.
What is common to all of them is a more or less complete
exclusion of the critical attitude. But an hypnosis as con-
 62

ceived by Liebault is very different matter from an hypnosis

in the Salpetriere, the hypnosis of Braid and Mesmer differs
from the modern hypnosis. "The suggestors " of the
modern shows produce again other conditions. Whoever
has seen a little of it knows that with the same technique
the condition of hypnosis changes with every hypnotist and
every hypnotized person.
Therefore what is essential is that the critical attitude is

excluded by some emotional impression, by fascina-

sort of
tion, domination, fright, or by a suggestion which depends
on these affects. All other symptoms of hypnosis are
accidental suggestions or accidental special reactions of the
individual which may vary from case to case. Whether
the subject "conscious " or not, whether he is in a sleep-
is

like condition, whether he has amnesia afterwards, all these

are entirely irrelevant matters and depend on accidental or
consciously given suggestions.
When the school of Nancy finds a resemblance between
hypnosis and sleep, it is as easily understood as is the fact
that others did not see it. Liebault expressly suggests sleep
and to the medium there remains nothing else but to
imitate sleep as well as possible.
The exclusion of the critical attitude by the affects and
also by suggestion is of every day occurrence and we need
sa3^ no more of it. The exclusion of other idea-complexes
we see not only as the action of the affectivity in a narrower
sense but also as a consequence of attention. Thus there
are no phenomena of hypnosis which can not be explained
by a simple inhibition and facilitation in the same way as
they are caused by the affects. But, in hypnosis it is easy
to bring about exaggerated results, i. e., to produce more
than is needed the affects may potentially do the same but
;

actually do so in exceptional cases only, i. e., only in very

profound emotional impressions.
 .

63

PARANOIA.

There unquestionably a group of cases in whom

is

delusions are the most prominent if not the only symptoms

of the disease. In these cases a system of delusions gradu-

ally develops without any disorder of the train of thought, of
'
will or of action. ' ( Kraepelin)
In this sense alone will the expression "Paranoia" be
used in the following" chapter.
If we apply our conception of affectivity, such as we
have developed it in the preceding pages, to paranoia, the
doctrine of this disease must appear to need revision. As
an example it may be well to enter somewhat intoSpecht's*
views on paranoia, which he has recently explained in an
able article. But these views seem to me to fail particularly
owing to his lack of clearness concerning the affects.
The author will pardon me if, for the sake of brevity, I
•acknowledge silently the good that I find in his work and
mention only that which departs from my own views. I
can do this the more easily because while our paths are
often in opposite directions we often arrive at nearly the
same conclusions.
Specht claims that paronoia arises from the pathological
of suspiciousness." According to him this affect
affect
consists of a mixture of feelings of pleasure and displeas-
ure, and is therefore also found in states of mania and mel-
ancholia as they pass over into convalescence or into their
opposites. Paranoia is the third psychosis to postulate
theoretically besides mania and melancholia.
My objections to this are :

1. Suspiciousness is not an affect.

2. It is not a mixture of pleasure and displeasure.
3. Paranoia can not be classed with the affect psychoses.

Ithought I had made all this clear, at least to some of my

colleagues, in an article in the Psychiatrische Wochenschrift,
1902-03, p. 255, but have evidently not succeeded, al-
* Specht. Ueber den pathologischen Affect in der chronischen Faranoia. Fest-
schrift der Univ. Erlangen Z. F. d. So J ahrigen Geburtstages Sr. Kg. Floheit
des Frinzregenten Luitpold von Bayerti. Erlangen und Leipzig. Beichert,
iqoi.
 64

though no valid objection to this article has come to my

notice. I may therefore be pardoned if I here go more into-

detail.
Suppose I meet a young man in a neighborhood which is-
not free from robbers. He seems to be a student and
carries a botanical specimen case. I have no reason either

to suspect or to trust him. If I meet a farmer with his

tools, who seems to be orderly and who has horny hands,
I trust him, I feel safer with him than alone. If I meet a
man whose dress, bearing and face bears the stamp of
dissipation I mistrust him. I do not know that he will do

anything to me, perhaps he is a harmless tramp, but he

might nevertheless be after my money. If the actions of
such a man in any way become more definite, if he, in an
unmistakable way shows a revolver, then I am sure that he
intends to attack me.
The essential thing in all these processes are perceptions
and interpretations, therefore intellectual processes. In the
case of the student I think neither of danger nor protection.
I know the farmer is not dangerous, I know that the one
who threatens is dangerous ; in the case of the suspicious
looking individual my observations and conclusions do not
suffice to decide me ; on that account I mistrust him. I can
describe the process in pure intellectual expressions without
speaking of an affect.
It is of course understood that affects may enter into this
occurrence as in every other mental process. The affect,

however, varies quantitatively and qualitatively, while that

which is designated by the word suspicion remains the
same.
If a person suffers from dementia praecox, for example,
a condition in which the affects are blocked, the fact that
his life is threatened may be a matter of indifference to
him ; the corresponding affect ma3 r
be lacking while
suspicion as such may be present. In a normal individual
the affects never entirely lacking, but they are not
are
exactly the same with any two men. A courageous, a
timid, a jolly, or a depressed individual, and whatever other
types we may think of, differ among each other in regard
 65

to the feelings associated with the same intellectual process.

In a depression or in a fighting mood a person may even
feel a certain joy in a situation even when he is aware of
great danger. Further, the affects change according to the
intellectual content of the suspicion, i.e
., according to the
threatening danger, even when the suspicion as such
remains the same (whether I suspect an attempt on my
life or on my purse, the suspecting is the same). If I
suspect that some one will steal my purse I have a different
affect than when I think that he will take my life or the
life of one of my family. Or if a person threatens to sully
my honor, I have an entirely different affect than when he
uses other doubtful means against me in the struggle for
existence.
Thus affects seem to be quite an unessential part of sus-
pecting. They may vary qualitatively and quantitatively,
may even be totally absent without a loss or change of the
suspicion as such. But if I take away the knowledge, the
intellectual process, there remains no single affect which
one can designate as suspicion.
Suspicion itself therefore can not be an affective but must
be an intellectual process. After all, the word suspicion
expresses nothing more than that one can not certainly
foretell, but still less can exclude the occurrence of an event

which one regards as unpleasant. To guess, to know, to

trust, to expect, to doubt, to be clear, to be certain, to
divine, are processes which are quite similar.
In the examples I have limited myself to instances in
which that which is suspected concerns the one who sus-
pects. According to the usage of the language I should
have made the concept much more comprehensive. We
may suspect that a rock may not be firm, even if it would
not injure any one if it fell, because it is one of the common
qualities of a rock to be solid. A roue may suspect that a
woman may not be virtuous, although he would like it if

she were not. We may suspect an enemy even when by

the expected attack he would give us the opportunity to
render him harmless ; or suspect that a person might injure
our enemy although we may be bad enough to enjoy this.
 66

In all these cases the affect is even more non-essential

because the supposed disagreeable thing does not concern
us. Finally the affect differs also according to whether we
suspect an object or a person. In order to make a conces-
sion to the conception of Sandberg and Specht we will,
however, abide by the narrower conception, and speak only
of suspicion in reference to injury of one's self by another.
What we have be all the more correct when
to say will then
referring to the usual formulation of the conception.
As already stated, suspicion is usually accompanied by
an affective process. Further we have defined it as the
uncertain expectation of something disagreeable. When
an accompanying affect is present it is naturally, in the
majority of cases, a negative one, but not always the same
one. But on careful observation we generally find that
besides the negative affect there exists also a positive one, as
in the case of an affect which we perceive when we expect
something disagreeable and find that it is not so bad as
we thought, or that it is averted. This affect is probably
similar to the one which is associated with hope. Hope is
both intellectually and affectively the best counterpart of sus-
picion. In both processes indications are present for the
realization and non-realization of a definite incident, but
they do not suffice for a definite expectation. In such a case
the affect changes as we think of the reasons why the one or
the other outcome should result. When I think only of the
reasons which cause me to be suspicious, the negative
affect is much stronger than when I, in the next moment
and with the same objective knowledge, place in the fore-
ground the motives which srjeak for safety. A similar
situation we find in hope. The affect fluctuates to and fro,

not spontaneously but in correspondence with the intellect-

ual processes. The latter, which no one can emphasize
more than we, are of course also inversely influenced by the
but the primary, the essential factor in suspicion
affects,
and hope is the intellectual process. Suspicion is almost
always accompanied by an affect belonging to a definite,
negative, group, but not by a definite affect. But a second,
positive, affect also plays a role, and, in the case of hope it
 —

predominates. Only in this sense can we agree that sus-

picion represents a mixed affect. But for us it is an intel-
lectual feeling-, as Nahlowsky uses the term, "an objective
process, '

' accompanied by two feelings which may vary

quantitatively or qualitatively without changing the nature
of the suspicion.
In the paranoia question there is yet another mistake.
"When Specht and Sandberg claim that the delusions of
persecution arise from the affect of suspicion, they mean
that there is a lasting affect upon which develops, in the
individual case, the suspiciousness.
Naturally the affective disposition is here as elsewhere of
great importance. If I am of an anxious nature or,
through some occurrence, am in an anxious mood, I turn
my attention more to the perceptions which point to danger,
and give these observations a great weight in my conclu-.
sions. If I am courageous or in an indifferent mood, the
intellectual processes are changed in the sense of these dis-
positions I become suspicious only with much graver
:

indications.
Therefore: There arc certain moods in which suspicious-
ness is more easily engendered than in others.
Can one on this account call suspicion an affect? Cer-
tainly not. There are different moods which lead to the same
result, such as anxiety, hate, the feelings of displeasure of
all sorts by which the suspected person arouses suspicion by
his appearance, his speech, or in some other way, for with-
out there being any question of an intellectual process we
trust a sympathetic person more than an unsympathetic
one, even if our dislike is founded on something entirely
subordinate, such as a peculiar nose or the like.
If we wish to designate suspiciousness as an affect, we
must differentiate it from the affects which dispose to sus-
piciousness. A person who has a tendency to hilarity need
not always be merry, the majority of comedians are said to
be of a melancholy temperament, and much goes to show
that they try to overcome the depressive mood by their
comic productions. In manic-depressive individuals the
same disposition leads to an increased readiness to elation
 68

and depression the euphoric mood is an excellent soil for^

;

anger. Thus we see that an affect which is aroused by a

definite occurrence need not be identical with the mood
from which it arises.
Just as an emotional so may an intellectual disposition
favor the formation of suspiciousness, such as the occupa-
tion with the thought of danger, the "feeling " i. e., knowl- (

edge ) of being alone, of bodily weakness or strength, the

consciousness of having much money in our pocket, etc.
Moreover the simple constellation, here as everywhere
else, plays a great part. If from external reasons I am not (

speaking here of the disposition caused by character and

mood) we have to think much in a definite direction, if we
have much associative material of a special kind at our
disposal, our thoughts are easily turned in this direction.
Occupation with a definite topic, whether it be affect-full or
not, always causes more ideas to be connected to it than
would otherwise be the case. This is undoubtedly one of
the reasons why writers of monographs overestimate their
subjects, why every disease with which we occupy ourselves
a great deal is found especially frequently we think of this
;

diagnosis more frequently. Thus is one

the constellation
of themost important causes of the delusions of reference
which, to be sure, are also favored by the affect.
/ believe with this I have done enough to establish the fact

that suspicion is an affect but that, as every other mental

not
process, it is accompanied by affects. These, hotvever, are not
constant and do not have in them the essentials of that which
we call suspicion. Certain moods and constellations, however,
favor the development of suspicion.
This also includes the explanation that suspiciousness is
not a combination of the affects of pleasure and displeasure,
although naturally the most frequent affect-state in suspi-
cion is a fluctuation between positive and negative affect.

* Bresler, Psych. Wochenshrift III, 171, assumes that through a disorder of the

feelings (which inform us of the comfort and discomfort of the ego) patients in
the initial stages of paranoia develop an uncertainty and therefore a suspicious-
ness. Here suspiciousness would also be a result of the emotional disturbance
and not the emotional disturbance itself. Of this hypothesis of Bresler I would
only state that the disorder of the emotions in paranoia has not been demon-
strated except in so far as it refers to the morbid ideas.
 69

There yet remains to prove that paranoia can not be

classed with the affect-psychoses" but is something entirely
different.
This part is most difficult for me because I am to prove
something- that to me seems very evident, or otherwise ex-
pressed, because I can not put myself in my opponent's
attitude.
The typical affect-psychosis is Kraepelin's manic-depress-
ive insanity, one may also include involution melancholia
and the "affective" (manic which are
or depressive) states
found intercurrently mental diseases. In manic-
in all other
depressive insanity the emotions are in an unstable equilib-
rium, they swing' over or under the normal or both. In
the other conditions we scarcely ever find a stationary
emotional change in one direction. In paranoia alone do we
meet a disorder which begins insidiousl} and which pro- 7

gresses during a whole lifetime, although variations occur.

This course alone speaks against a parallelization of par-
anoia with the affect psychoses. In addition to that we
find in the latter affective changes before the delusions
appear, while in paranoia we would have to assume such
affective changes b}^ means of a very doubtful hypothesis,
because what we can actually observe are adequate emo-
tional reactions to delusions. If we distract the patient's
attention from these we are unable to find any disorder of
the affects. On the other hand, in mania and melancholia
this is rarely the case, and then only in the milder
instances.
Again Specht's comparison of paranoia with the affect
psychoses is incorrect because it is not true that the mixture
of elated and depressive moods, in the convalescent state of
acute attacks of manic-depressive insanity, has a special
tendency to cause suspicion. I have most frequently seen
suspicion during the depressive, phase, and at times in
mania, while in the convalescent stage of the latter, irri-
tability is one of the most frequent transformations of the
manic affect. I have described a case of manic-depressive
insanity in which two purely depressive phases were so
dominated by suspicion and delusions of persecution that
 t

70

7"
chronic paranoia was diagnosed by a competent observer.*
The patient had exclusively depressive affects, f can now

add that he has since had a rather long period of hypo-

mania Avithout suspiciousness from which he recovered.
The mixture of manic and depressive affects, therefore ;
:

does not produce suspiciousness.

Very important is also the fact that manic and depressive •

patients retain their affective states in the face of the most

varied experiences. The worst paranoic, however, connects
his suspicions with only a small part of his experiences.
Therefore if anwere at the bottom of the suspicious-
affect
ness, it would have to be one that could appear and vanish
from minute to minute, I could almost say, from second to
second. A paranoic may not only hear a whole sermon but
he may associate for weeks with others, while of all of the
experiences of this time only a single sentence from the
sermon will be interpreted in the sense of his suspicions or
of his delusions; therefore a condition quite different
from what we But the sus-
see in the affect psychoses.
piciousness is lacking not only in connection with a great
majority of experiences, but every paranoic shows with his
distrust of individual persons at the same time a trust for
others which has just as little ground. I, at least, have

not observed any paranoic who did not show this s3r mptom v

which as time went on, changed to hate if the person

who had formerly been trusted, did not fulfill his wishes.
Kreepelin describes the same phenomenon in paranoia
quaerulans as pathological credulity.
And last but not least, the paranoic, in pronounced cases,
is not at all dominated by suspiciousness. We will not
speak of the other forms, but even the person with delusions
of persecution as a rule does not suspect, he knows that he is
persecuted and is so sure that a normal individual scarcely
knows anything more certainly. A discussion with him is

often absolutely out of the question, for him there is no

reason which can be advanced against his views.
* Psych. Wochinschrift. 1902, No. 11.
•
Wnm also the normal opposition of belief and caution which otherwise-
governs <>ur attitude, is so far changed that both forces seem increased, or
act separately without the possibility of mutually diminishing each other.
 .

71

If we take, however, the paranoic not with ideas of per-

secution, but the great class of cases with delusions of
grandeur we find in the foreground the opposite to suspi-
ciousness, a great trustfulness and hopefulness, to be sure
only seldom directed toward others, but generally referring
to the patient's own efforts and discoveries. Nevertheless,
it is characteristic for the opposite of distrust that an erotic
paranoic will only infrequently get the idea that his beloved
is unfaithful to him even in spite of her repulses.

While we see that not all paranoics are distrustful we can

on the other hand observe that there are very many dis-
who never become paranoic. I know of a
trustful persons
woman who has remained single simply because she can not
trust any man enough to marry him. She can scarcely
purchase anything in a shop because she fears that she
will be cheated. She is not paranoic.
Therefore paranoia can exist without suspiciousness and
excessive distrust docs not necessarily lead to paranoia. Con-
sequently paranoia must be rooted in some other quality.
In conclusion : Suspicion is not an affect. Paranoia on
account of its different course can not be placed among the
affect psychoses, hi many patients with dehisions of persecu-
tion we find associated with suspiciousness an abnormal trust
in some other individuals Paranoics with ideas of grandeur
.

and similar delusions do not have an excessive suspiciousness

And even in paranoia persecutoria the suspiciousness has a
conspicious role only in the beginning of the disorder and even
the7i not always. In the fully developed para?wia, on the
other hand, the unshakable and indisputable knowledge {the
delusion} sta?ids in the foreground. Suspiciousness does not
lead to this certainty but stands in a certain contrast to it.

I would like to briefly review a few other points in

Specht's work which seem to me to require special discus-
sion. But it is impossible to go over all that has been
written of the genesis of paranoia.
Page 5. "It is a pity that the primordial deliria, in spite of the
fact that they were first described by Griesinger, prove to be more
 12

and more an unfortunate invention." I must admit that I doubt the

'

existence of ' primordial deliria '

' in paranoia. Unfortunately,
however, we can not as yet genetically explain all the apparently
autochthonous ideas in dementia praecox which later become fixed
delusions, and therefore we can not as yet dispense with either the
name or the conception.*
Page
S. According to Specht only false ideas whose central point
is the ego are delusions. "It is therefore not a delusion when a
patient considers a pebble to be a diamond. But is it a simple error ? '
'

I do not, at present, know

any other name for such a phenome-
of
non. I have given several examples of delusions which are not
ego-centric in the Psych. Wochenschrift, 1901-02, page 256. If Neis-
ser {Ceniralblatt f. Nervenheilk und Psych., XXVI, 230) considers
my ideas,
'

especially as far as they contradict the ego-centricity of

'

the paranoic delusions," as invalid he has read incorrectly for I

speak there of delusions which are not ego-centric only so far as de-
mentia praecox is concerned, and therefore do not materially differ
from his opinion. What I say is, that at present we have no right to
limit the name
delusion to ego-centric delusions as Specht does.
However, for question in hand this is not essential.
I would like, however, to call attention to the fact that the example
of Specht on page 10 is
'

believe in witches but

incorrect. ' One may
not that one bewitched without raising a suspicion of insanity."
is
Waldau Asylum, where I was assistant physician for several years,
draws its patients from regions where the belief in witches (capuchins,
etc. is yet prevalent.
) A person from such a place naturally assumes
the possibility of such influences in his own case, especially when a
striking disease or an accident gives him occasion. In Burgholzli we
get, for the most part, people who do not believe in witches. Any
one in this region who believes in witches, whether he imagines him-
self bewitched or not, is usually either pathological or distinctly
insane. The difference between the morbid idea and error here lies in
the origin in the latter case a development of an independent trend
;

not in contact with reality, paresthesias, peculiar feelings in regard

to the train of thought (such as a feeling of blocking or of being
obsessed, compulsive actions, etc. in the first case the influence of
) ; :

a general suggestion which only an especially strong mind can

resist.
The utterance one of Ziehen's patients "the universe becomes
of
fat, black is deum laudamus which is evidently that of
not black, te '

'

a paranoid hebephrenic, can not be discussed in this connection

because no one, without a further analysis, has any idea what the
patient wanted to express, perhaps it was something which in the
speechof normal individuals can not be expressed at all.

* In the next volume of the Zeitschrift f. Psychol, and Neurologie Drs. Jung y

and Riklin will show that the mechanism of the origin of this kind of delusion
can^be traced further back.
 73

Page 10.That "our consciousness would be without a real founda-

tion were not supported by the immediate experience of the ego
if it

which is given to us by our feelings " must yet be proven even if the
feelings in many respects appear to be the most essential part of the
ego.*
Indeed the term "immediate experience of the ego" seems to me
to be based on a misconception. In our mind there are no other
than immediate experiences. Of these, those received through the
-senses as well as the hallucinations, are secondarily projected out-
wards. Those which are not thus projected belong to our inner ex-
perience. I can not understand how in these two chief classes or in
addition to them there can be an immediate and, for that matter, a
mediate experience of the ego.

On pages 12-13 Specht regards the feelings of rnorbid

which the sensory
self-reference as a process of perception in
stimulus must co-operate with reproduced sensory material
which already appertains to the personality. "The sub-
jective complement is an indispensable essential of every
clear perception and the morbid self-reference is only a
special instance of this association process. Since I have
found that this or that occurrence has for me this or that
meaning, every similar experience must with psychological
necessity call up the self-referring associations." In the
"for me" there is an unsuitable generalization. It is

indeed correct that our psychological experiences are

essentially our own, but there is a great difference between
the experience in the perception of an object or an incident
which we and the reference of the
attribute to all others
perception to the ego, i. and morbid self-
e., the normal
reference of which Specht further says "This process only :

begins to be abnormal when it appears frequently and with

evident one-sidedness.' What is here added to the sensa-
'

tion is something entirely different from that which is added

when I refer the appearance of a man or object to myself.

In one case I simply add to the sensation something which

always belongs to it and which others add to it under the
same circumstances, in the other case I add an accidental
reference to myself.
According to Specht the most important thing in West-
phal's soldier who, when wearing a new uniform, thinks
* Many school teachers, who think a man consists only of memory and perhaps
also of a little intellect,forget this.
 74

himself observed by everybody, and Cramer's partly dressed

man, is that they ascribe a certain approving, admiring,
scornful or hateful tendency to the looks of the people who
see them, and this side of the phenomenon explan-
finds its

ation of course only in the mood of the one who thinks

himself observed.
This is not necessarily so.
I remember similar situations where I (wrongly) assumed
I was observed partly in direct opposition to conscious
reflection. The valuation by those about me of my person-
ality or clothing was quite in the backgroud if it played
any role in the "feeling of being observed." The essential
thing, according to my experience, is that I am constantly
occupied with the idea of new clothing, the new dignity,
or with the defective clothing. I continually feel and see
the unusual clothing andmy whole endeavor to cover up the
defect determines behavior and therefore occupies my
my
mind to a considerable degree. Everything that we do in
such a case touches continually a part of the actual (also
unconscious) association-complex of the clothing. If, at
this time, some one talks of philosophy or politics we scarcely
connect these themes with the idea of clothing, but if any
one looks even in the most ordinary and casual fashion,
at us
that usually would be unnoticed, these looks are referred to
the associations nearest and constantly at hand, viz.: to the
ideas of clothing, the overvaluation of which is transferred,
according to well known rules, to the closely associated
ideas of being observed.
In such cases it is therefoi'e a matter of constellation.
Inversely On a journey I wear, for comfort, a, to me,
:

very pleasing but at the same time a rather striking suit.

Since I am comfortable I do not notice it. I know, however,
that others, especially those who know me may possibly make
fun of meabout it. This I am able to put up with without
however being indifferent to it. Nevertheless I develop fewer
ideas of reference than one would expect under the circum-
stances. Since the thought of my clothing is lacking, I do
not associate the looks of the passers-by or my fellow-trav-
elers to my clothing, and when another thought is aroused
 75

in me all and therefore remain

they are not associated at
unnoticed. Here the unusual constellation which pro-
duces the singular reference to self is lacking.
One can naturally say that I have connected the stronger
affect with the stronger feeling of reference. I believe,

however, that I am sufficiently able to observe myself and

feel convinced that my view is correct.
we look about us we will find thousands of cases of
If
the inclination to connect new experiences to an idea which
occupies us at the time (writers of monographs!). It is
quite natural that an affect plays a part in this, for the
affect gives rise to overvaluation of an idea* and often
forces us to occupy ourselves with it. But even then it is
not necessary that the affect be the cause of the association
between the new impression and the existing complex. It
only accounts for the continuous presence of the idea so
that an incoming stimulus finds it ready and becomes
associated with it. The soldier notices the looks of the
passers-by because his pride or the unusualness of his new
clothes keeps the idea always in the foreground, not
because he ascribes to his fellow men a tendency to admire
him. The person with the defective clothing may be quite
certain that those he meets take a sensible view of it or are
wholly indifferent to it, but as long as he thinks of his
defective clothing he feels that he is being observed more
than he ordinarily would.
Therefore there does not need to be any affect to produce
a physiological feeling of reference. It is sufficient that
any idea be constantly in the foreground (frequent occupa-
tion with some definite object, for example), for the
chances of its association with new incoming impressions-
to be increased almost indefinitely. In spite of the great
importance of the affectivity the action of the constellation
in the associative processes must not be entirely over-
looked.

Page 15. The morbid self-reference according to Specht occurs

only in psychoses with emotional abnormalities. But are there

* I use this expression in a somewhat wider (not pathological) sense than its-
originator, Wernicke, did. ,
 .

76

psychoses without emotional abnormalities, since, he has attributed

paranoia, the intellectual psychosis par excellence, to siich abnormal-
ities?
Page Specht should have defined more clearly what he means
16.
'
h>- the Steigerung des Selbst-gefiihls
' (something like a heightened
'

'

feeling of self), which according to him is the foundation of the de-

lusions of grandeur. For me, at least, the expression has no clear
meaning unless it be simple overrating of one's own powers. When
a person thinks that he is better than he actually is, it is not an affect
but a question of internal or external perceptions or of false con-
clusions. Yet it is an intellectual process which very easily arises as
a result of an exalted mood.
Page 16. That ever}* paranoic has delusions of grandeur is doubtful.
Many with ideas of persecution only place their personality into the
foreground in so far as it is a natural result of the idea of persecu-
tion. Every normal individual Avho is persecuted does the same, al-
though not in a paranoicly exaggerated fashion. At any rate
delusions of persecution are not conceivable without producing
secondarily that which we might call delusions of grandeur. (Com-
pare our first case)

On page 21, Specht asks why we are so set on regarding

the emotional disorders as secondary when even the pa-
tient's own statement goes to show that thisThe is not so.
answer is we do not see the primary emotional
very simple ;

disorder. A paranoic, when once his delusions are formed,

appears to us to be emotionall}" normal. What we see in
him in this respect appears to be a' normal reaction to his
('false.) ideas. If we say nothing to him of his delusions
we notice no abnormality in his moods, even if we know
it. All his affects appear to be those of a healthy man.
It is entirely different in a depressed patient or in a manic
patient. Here even to the casual lay observer the emotional
disorder dominates the picture. It shows itself in indif-
ferent conversation, as well as in conversation about the
delusions, only in the latter case it may be increased.
Since we can not observe the emotional disorder in paranoia
it is hard to assume it, as far as it is a question of a general

emotional disorder as Specht and others say.

It is also contrary to my experience when Specht on page

22 says that the paranoic with delusions of persecution at

the height of his disease is more or less dangerous to the
community. According to him this could not be explained
 77

if their feelings were normal, but in that case every jealous

husband, every person who had a grievance must also be
dangerous. In the first place it must be noted that many
paranoics never become dangerous to the community (these
are seldom seen in an asylum) and that there are, after all,
very few non-paranoic individuals who for years and years
have been persecuted with such persistency and chicanery
as a paranoic thinks he is, but nevertheless even such an
individual may get to a point where he commits murder.
In this respect, therefore, so far as one can judge, the par-
anoic acts scarcely differently from a normal person, and it
is certainly a mistake to judge from an occasional reaction

of this sort, that there exists a general emotional abnor-

mality.
It is also incorrect to say that every normal man becomes
indifferent to continual persecutions. Many become more
excitable and react only after years. We have in the hos-
pital now a very nervous but not paranoic man who was
constantly tormented by his wife, but only shot her after
seven years of this life and how numerous are the cases of
;

persons who only after years of ill-treatment get to the point

where they leave their positions.
Page 25. The subjective situation
'
is correctly outlined
if we regard the general idea of being persecuted as such a
'

feeling. Here the inaccuracy of the concept feeling

'
' '
'
' is

well shown. Is there a "feeling of being persecuted ", if

one regards feeling as a part of affectivity as Specht has ex-

pressly done? In the case in hand the word designates an
"intellectual feeling" (Nahlowsky), a purely intellectual
or, according to others, an "objective" process. I can

know that I am persecuted, I can suppose it, I can feel it,

i. e. conclude it in an indefinite fashion from various occur-

rences. All these are intellectual processes but naturally,

as in the case of the majority of other intellectual processes,
they are accompanied by " feelings " in the sense of affects.
The correctness of our conception is shown in a striking
manner when Specht further says that there are things
which one can feel but not prove. What has such a
feeling to do with affectivitv ?
 78

Pages 25-26. If the " bellicose delusion of persecution is conquered

over night by the faint-hearted idea of sin or injury " it is no proof
for the fundamental nature of the emotional disorder in paranoia. A
normal person, continually persecuted, is seldom permanently free
from faint-hearted moods. Therefore, I also fail to see why an idea
should be more capable of resistance if it is the product of a primarily
disturbed intellectual activity.
Page 27. " The paranoic affect as a mixed affect lacks the evident
According to Specht, page
'

upon the behavior of the patient.

effect '

18, defiance, anger,quarrelsome exaltation, are also mixed affects.

Nevertheless these are associated with very distinct modes of ex-
pression. The mixed nature of the paranoic affect would therefore
not explain such an absence of effect upon the behavior even if sus-
piciousness were an affect.
If this affect of suspiciousness is not noticed because it is so fre-
quent in normal men, then moderate degrees of exalted and depressed
moods must not be noticed because they are still more frequent. "We
notice them, however, even in the absence of tears and we consider
them pathological when they are no longer adequate to the circum-
stances.
Page 30. From the prevailing notion of paranoia Specht draws the
conclusion that the criminal judge can hold the patient unaccountable
for his acts, if, for example, it is a question of a false accusation on
the basis of insane ideas, but not if the paranoic has killed his alleged
opponent. He claims that if there existed no (general) emotional
disorder and only a (partial) intellectual disorder the crime would
only in the first case be dependent on the disease. Without referring
to other reasons for objection I would only like to call attention to

the fact that the disposition which could lead to merely an intel-
lectual disorder might just as well be general as the emotional dis-
order which Specht assumes. On account of this objection, therefore,
we would not have to change our medical testimonies in court.

Let us in conclusion say something- of the limitation and

uniformity of delusions ofpersecution and grandeur. Specht
explains this by saying that the underlying feeling has
only two fundamental qualities, those of pleasure and dis-
pleasure. This would only be correct if all feelings could
be aligned between pleasure and displeasure. This, how-
ever, is open to question. For this reason the fact that
('page 18) defiance, anger, discontent, quarrelsome exalta-
tion, can not be classed in the two categories of pleasure
and displeasure does not mean that they represent a mix-
ture of pleasure and displeasure. They may also be some-
thing entirely different. Moreover, if there are several
 79

mixed affects why should there be only one psychosis which

corresponds to the mixed affect of suspiciousness, why is
there not an anger psychosis and a quarrelsome exaltation
psychosis ?
That only mania and melancholia play a part in the
(acute ) affect-psychoses is easily understood. Pleasure and
displeasure are the simplest affects so far as their dependence
on our bodily condition is concerned. We can easily con-
ceive that these general affects correspond to a definite
bodily condition. The special and more complicated affects,
however, can not have such a general cause, just as we can
not conceive a pathological stimulation of the acusticus
which causes us to hear words, while in this manner simple
sounds and inco-ordinated noises are aroused every day.
We shall later give a preliminary explanation of the
types of delusions of paranoia. The above are the most
important objections to Specht's view. I would like here
to refer to the fact that Storring* has never been able to
note that ideas of being observed or ideas of reference pre-
ceded ideas of persecution, and that he observed delusions
of persecution in anumber of cases where there certainly
were no delusions of reference present.

We must now consider the common view, that the cause

of paranoia due to some sort of hypertrophy of the ego.
is

This is easily demonstrated in the well-developed disease if

one comprehends the idea somewhat broadly. It is self-
evident in all forms of gradiose delusions. In the delusions
of persecution some deduction is necessary to demonstrate it.
A person who sees a large number of opponents against him,
who knows that some one is making almost unbelievable
efforts to harm him must, so one says, logically conclude that
he is worthy of such efforts. This is supposed to explain the
so-called transformation of delusions of persecution into
delusions of grandeur. About the existence of this trans-
formation I can not help being sceptical. Many paranoics

* Psyclioftathologie, Leipzig^ /goo.

 80

do not draw this conclusion and their logic fails if one would
have them do it, just as when one tries to show them the
it does
foolishness of their delusions (compare Case l). An hyper-
trophy of the ego in the above sense is therefore not a
regular occurrence in paranoia. It is further said that the
delusions of reference point to the fact that the ego has
niore associations than normally so that a great mass of ex-
periences, which otherwise would be unnoticed or remain
in other connections, are connected with the ego complex.
This also is not a gradiose tendency nor any other sort of
pushing forward of the ego, for when such a complex,
from associative reasons (constellation) or from emotive
reasons, comes into the foreground and is almost continu-
ally present in the mind it is naturally associated with
everything. Moreover, without this kind of "self-over-
valuation" a delusion of reference is not possible. Hence
to postulate it means begging the question.

In the Psychiatrische Wochenschrift, 1901-02, page 255, I have said

that not even the broader conception of the pathological ideas of
reference suffices to explain the megalomanic forms.* Tiling (loc.
cit.page 434) thinks that I have overlooked the fact that normal as
well as abnormal people are not cold-blooded at the conception of an
important idea but that there goes with it some affect of pride or of
love. I am of course aware of this, but I think that when a normal
person conceives such an idea and has with it a feeling of pride, he
does not necessarily have an hypertrophied ego and therefore there
is no reason to assume this when a person gets such an idea by
means of false instead of correct reasoning. If the ego is really
hypertrophied or too much emphasized by feelings this would have
to show other ways as well. I gave as example the persons
itself in
who constantly push forward their own personalities and their own
names, which fact in general, not in every individual case, gives a
certain index of the role which the ego-complexj)lays in the thoughts
of the individual. Tiling therefore seems to me to be wrong when he
says :whether the ego expressly appears or not is a matter of
'

'
'
'

indifference, all the fibers of the emotional life are concerned in the
idea." should like to see a mental product in which all the fibers
I
of the emotional life are concerned and in which there does not exist
a subjective coloring in the sense of pushing to the foreground the
ego. Hence we can not admit the primary significance of the hyper-
trophy of the ego for the origin of paranoia, because we frequently
find a special emphasis of the ego only when this is naturally

*Specht also writes, p. n, "The paranoic delusion, especially the delusion of

grandeur, can come into existence without any peculiar feeling of reference."
 f

81

expected, and when it would be seen under the same conditions in

normal individuals as well while there are many non-paranoics
;

who suffer from such an hypertrophy.

For similar reasons we must reject the views of Berze*
which really only condense and make more precise what
many others have already supposed. He says that the
psychopathological foundation of paranoia is a derange-
ment of the apperception, i. e., a difficulty of raising a
mental content into the focus of attention. This derange-
ment causes a feeling of passivity like passive apperception
and interferes with subsequent apperceptions which would
readily follow in the normal.
This conception is wrong because only a very small part
of the perceptions is changed. Even in a marked case
many thousands of normal apperceptions occur to one
which is, in the paranoic sense, falsified. It is also not true
that to the paranoic everything seems different than for-
merly, as many, who assume a primary emotional disorder,
would maintain. Naturally much must appear different
because it is perceived in a different relation. Every
normal person may observe that in himself. In the picture
"where is the cat " we see the cat or the tree, each accord-

*Das Primarsymptom der Paranoia, Halle, Marhold, igoj.

tThe change in the appearance of the environment that is frequently claimed
to exist in the beginning of paranoia, I have not as yet seen in a paranoic. On
the other hand not at all uncommon in the different forms of dementia
it is

prascox. I can therefore not repress the thought that the cases where the
symptom is not produced secondarily by the affective or intellectual disorder of
paranoia, belong to the paranoid form of dementia prsecox. All my experi-
ence is opposed to the assertion that the paranoic apprehends everything in
a changed manner. (Tiling Individnelle Geistesartung, Wiesbaden, 1Q04, p. 242).
I have also not been able to see that the " Kern des Individuunis " (the center of
personality) is changed (Tiling, p. 43). Moreover, such an observation, in spite
of the statements of Tiling, would hardly be in accord with his endeavor to
derive paranoia, especially the originary paranoia directly from the mental
makeup of the individual. It would be of the highest theoretical importance if
one could demonstrate the general derangement of the mind or of the brain in
paranoia. As yet only a partial derangement is perceivable to which the other,
striking, symptoms are secondarj^, but normal, reactions.
In some cases of affect-ps3'choses, especially in melancholia, the patient some-
times declares that everything seems changed. A very intelligent teacher,
after recovery, told me that everything seemed to be covered with a grey ash,
although she recognized the colors quite well. I have noticed the same
symptom in myself for a few minutes in a normal depressive affect. I can not
better describe it than above, although that description does not cover the con-
dition exactly.
 82

ing to whether the attention is focused on the tree or on the

cat. One can conceive in different waj^s, geometrical
figures, especially if they consist of points. Orders which
we have given under certain conditions often appear in
other connections as something entirely different so that we
do not recognize them when they are mentioned in such
connection. Here it is always a. matter of constellations,
of associations, and, as I will here emphasize, this may not
only have affective but may just as well have purely intel-
lectual reasons.
It is easily understood that much in the new affective and
intellectual relations must appear very different than for-
merly. That all appears different is incorrect.
The circumstance that the formation of a paranoic
delusion takes time is another reason why it is difficult to
accept a primary perceptive disorder in paranoia. Unfor-
tunately I have insufficiently recorded my observations in
this regard,but as far as I remember all the many cases,
which formed a delusion and the corresponding reaction
immediately from a word or perception, belong to dementia
praeeox. In Kraepelin's paranoia I can recall only a more
gradual formation of delusions. When Case I comes from
church she often does not think that the preacher has said
anything about her this time. But frequently the delusion
then arises in the night or sometimes only after several days.*
An incubation of several hours is generally observed.
We find the same thing in the origin of traumatic hysteria.

The view of Linke is also refuted by this presentation.

Linke (Allgem. Zeitschrift f. Psych. 1897, p. 567) saj^s:
"The underlying cause of the delusions in primary-
paranoia is the increase in intensity of perceptions which is
determined by the pathological affect conditions (expectant
attention)". According to Linke the ideas of self-abase-
ment correspond to depression, the ideas of grandeur to
euphoria and the ideas of being observed to expectant
attention.

*I have seen a paranoic who only formed her delusions from paramnesias.
The illusions of memory occurred usually a long time, up to a year, after the
given occurrence.
 83

For similar reasons the view that the change in the

memory pictures (Wernicke) give occasion for the formation
of delusions must be
rejected. Of millions of memory-
pictures, even in the most marked cases of paranoia, only
a very few are really falsified, namely, those which are
brought into relation with the delusions. This selection is
analogous to the predominating falsifications of memory
of normal persons who recast the memory-pictures accord-
ing to their desires. The illusions of memory * are certainly
secondary and not the cause of the disorder.

The observation of paranoia shows another connection of

the delusion with the affects, which, so far as I know, has
not been sufficiently considered. It may be illustrated by
histories of a number of cases.

Case 1. Female, single, protestant, born 1853. The only living-

brother of the patient is very frivolous and a moderate drinker.
Otherwise as far as is known no psychoneirrotic heredity.
there is

The patient until the outbreak of paranoia was mental^ and phys-
ically normal, cheerful, not eccentric. Always respectable, indus-
trious, orderly. According to one report she was headstrong and
easily excited. The latter was corroborated by the patient. This trait
is not especially marked now. She got along well in school and
attended the secondary school for two years. Before she left school her
father, on account of severe lead-poisoning, had to give up his occu-
pation as a painter and took up a delicatessen shop. The father died
some two years after he had been in the shop] (in 1S70) which, although
it had gone fairly well, came into bankruptcy. The mother recovered
her dowery. An uncle of the patient, husband of her father's sister,
who was well situated, had taken over the shop and had advanced
money for it, The
shortly before the death of the patient's father.
patient was bound over, by the contract manage the shop.
of sale, to
Some two years afterward she relinquished the situation. The reason
for her so doing is the single unclear point in her life. She remem-
bers that she gave notice and that the uncle gave the shop over to his
housekeeper who later became his second wife. She then went as a
maid to a nature-cure establishment where she remained a year but
she had a feeling that the cure was a fraud. A patient there procured

Unfortunately owing to the scarcity of paranoics in hospitals we have not

succeeded in analyzing a case according to Freud s methods. The case in the
Neurol. Centralbl. 1894, is undoubtedly one of dementia prsecox. In the latter
disease the demonstration of Freud's mechanism is very easy.
 84

for her a situation as a nurse girl in French Switzerland, '

because I
'

always had an idea at that time of learning languages or something

else that was useful. " She prospered there but after a year and a half
had to return home on account of a severe illness of her mother.
After the recovery of her mother she was occupied with making
copies in a recorder's office but the income was small and irregular.
The same friend who had procured for her this work secured for her
a position of trust in a goldsmith's shop (1875), where she was book-
keeper and had control of the workers in silver and the incoming
and outgoing of the silver, especially of the waste. She was there
three years when her uncle again called her to his shop on account of
the death of his second wife, 1878. At the same time his son came
into the business and house. The father and son had children of the
same age and there was often trouble in the family. Both parties told
the patient their troubles which naturally was very disagreeable for
her. "I was always between the hammer and the anvil." She also>
probably thought that the conflicting parties would hold her respon-
sible for the bitterness of the relations, as a normal person might also
think. In 1881 she went to her mother and supported herself by
making cream bonbons and Hilpen, a special kind of Zurich pastry.
The two women were always overwhelmed with orders and over-
exerted themselves with the work which required much care and also
made large demands on their physical energy.
In 1888 a peddler who had taken most of the Hi'ipen became ill.
The patient began to complain that if the peddler died she could not
dispose of her goods. She made various plans how she could help
herself but she had to discard them. At the same time the idea came
to her that certain people would not be sorry if she could not make
both ends meet. Afer a few weeks the peddler recovered and
every thing went on as before, and she also corrected every fear
and the beginning idea's of persecution. In 1889 the peddler died
rather suddenly. The distress began anew and indeed was intensi-
fied. She thought that in order to procure a sure means of existence -

she would take up a branch of a provision business. Through the

help of her uncle she was able to do this and signed the contract.
While she was signing the contract, however, the doubt came to her
whether she could succeed in this business, and on the next day she
cancelled the contract.
The disease now begins. Ruin seemed certain to her. She felt she
.

did not earn what she ate. She reproached herself because she her-
self had not peddled her goods although this would have been impossi-
ble, and the shop was doing well. According to her idea the customers
who came into the shop did it only for show, really they would
soon stop purchasing anything from her. She became more exact in
the preparation of the goods and reproved her mother if she was less
exact, while formerly she had always followed the latter's direction.
She must have been conscious of this because she heard a neighbor
 '

85

say had such a child I would give it a rawhide and would

once, "if I
not give anything to eat, and referred it to herself. The logic
it
'

'

Avith which she proved this to be correct is characteristic. She had

certainly been rude to her mother. The house was permeable to
sound. The man was a drinker and always made such coarse
speeches. The first reason is in truth only a probability that she was
meant. The others are proofs for the possibility that the man had so
spoken that she would hear it. For the patient this is a certain chain
of conclusions that she was meant.
She heard many people speaking about her. One said that she
must yet go begging. Then some one criticized her actions and made
remarks such as, " now she does this or that. " Once when she was
sewing, a physician, who had been called without her knowledge,
came to see her. Then she heard the janitor say, "now she sews,
•usually she does nothing.
'

time the most important thing, according to the patient's

x\t this

account, is that she heard the landlord say on one occasion that he
had thought there would come a time when they would take revenge
on her. She immediately thought of her uncles and cousins who had
something to pay her back. Formerly she had never thought that
these people could have anything against her, excepting the indefin-
ite thought that she was partly responsible for the trouble between
them.
The patient states that she has never had hallucinations, and she
knows exactly what is meant by that. Everything has been said
under circumstances where it was possible that some one spoke and
with a natural localization. Nevertheless the above related occurrences,
but only these, arouse the suspicion of hallucinations or illusions.'
Later, and also in the asylum, where for years all her delusions were
subjectively and objectively analyzed, no trace of hallucinations ivere
found. To be sure the patient often related something which appar-
ently could only be an hallucination. But if we requested a more
accurate wording, which we could always secure if we had patience
enough, or if we determined objectively what was spoken, without
exception it was shown that we were dealing with a false interpreta-
tion in the sense of self-reference.Bui it is very hard for the patient
to speak or think of the zvords she has misinterpreted without self-
reference. She thinks she is giving an accurate account in relating
that the preacher said that she was going to be miserable, when really
he had only spoken of misery in a general way. It requires a very
energetic request to get her to give the real wording and even then
she reproduces it a few seconds later in the way corresponding to
the delusion. A deliberate luisrepresentation is, without any doubt,
excluded owing to her truthfulness and her interest in the psycho-
logical analysis. It is remarkable that, at least during her present
admission to Burgholzli, all self-references are not made immediately
after the critical occurrence but only after several hours, very often
 .

86

only on the following day or even later. The delusion of reference-

requires a certain incubation time for its development. Further it
may be important that it has never happened that a real reproof has
been interpreted erroneously. And occasions are not lacking, for in
spite of her capability and conscientiousness the complexity of her
tasks and her frequent distractions on account of her delusions, cause
her, now and then, to make mistakes. She always accepts the re-
proofs with a ready comprehension and modesty. She always con-
nects her delusions to things which are indifferent to a normal
person. When she is reproved for some real mistake the thoughts and
feelings are directed by the circumstance, but in indifferent speeches
the individuality has a freer hand. Perhaps the explanation of this
remarkable fact lies in this difference.
About the end of 1890 the preacher in one of his sermons said
"whom God has helped in the past, will He also help in the future."
In this sermon she heard only the first part.
'

Whom God has

'

helped in the past." She referred these words to herself God would
:

not help her in the future. From this time on she heard continual
reference to her future misery in the sermons of the different
preachers.
In order to be away from home she went one time to a friend whom
she helped in the housework. When she worked in the kitchen she
thought that some one watched her from the other room through a
hole behind a bookcase. After it was proven to her that there was
no hole there she thought of another way, a mirror for example, by
means of which some one could watch her. A baker had burned a
cake which had been given him to bake, and she thought that he had
done it to show her that she was not doing right. (These ideas she
now corrects)
In thesummer of 1891 she went to Darmstadt with an acquaintance
who was going to introduce a manufactory of the kind of pastry she
used to make. But after a few weeks she had to return. She was not
able to work well and the people followed her with slanderous
reports, more than formerly, all of which referred to her ruin and to
the fact that she could expect no more help. At home she thought
she could work better with her usual utensils but she had deceived
herself.She could do almost nothing. She said herself that she
was scarcely able to knit. She had already expressed the idea of
suicide.
She was brought to Burgholzli August 18, 1891, with the diagnosis :

Melancholia. Here her complaints were the same as outside and she
desired to go away. There was nothing for her to do here. They
had told her that she would be able to work here and therefore
she had brought a lot of old clothing with her to mend. Now
they made fun of her because she had brought the old clothes
with her. They watched her secretly. It was foolish to keep her
locked up in a place where she needed money and earned none. She
 87

suffered the more because she saw that she was being observed.
Every one knew all of her doings and luade fun of her because she was
loafing and earning no money.
In the latter part of 1891 and the beginning of 1892 she received
from her cousin some writing to be done in the institution. She did
it very well, but was not content because she thought she was paid

more than her work was worth and that she should therefore not
accept the money. On the other hand she occasionally also com-
plained of her relatives and said they were not helping her as they
had promised. She frequently wept over her condition, especially
over the fate of her mother who could not support herself. From the
beginning of her stay in the institution she had worked industriously
and she was orderly in her behavior. When there was a question of
her release she requested that her cousin find her a place, then she
thought she could not accept it but must remain with her mother.
On February 9, 1892, she was discharged as improved to her mother
with a diagnosis of paranoia. In spite of the fact that her mother
told her that she had more orders than she could fill she did not dare
to take up her former work. She thought that the orders would only
continue until she came home and would then cease. After some
time she was more certain of herself, but nevertheless she sought
several customers before she would again take up the work of pastry
making.
The disease, however, was not cured. Every one gave her to
understand that she could earn no more and that she would yet have
to go to the poorhouse. The preacher especially continually made
such allusions. The idea of suicide became more prominent and
only the thought of her mother restrained her. In February, 1895'
she tried to freeze herself. Then she was in a private institution for
several weeks and was discharged improved. After this she luade an
attempt to drown herself, but desisted in time. The next two weeks
were comparatively quiet. The patient could work but often told her
acquaintances that she was in a bad condition financially and some-
times asked for their help, although in reality the business was pros-
pering. She gradually grew worse and accused other people, espe-
cially her uncle and his son, of being the cause of her misfortune.
Generally, however, she threw all the guilt on herself.
One morning she poured petroleum over herself and set fire to it.
When she was ablaze she cried for help and was rescued after receiv-
ing some severe burns. In the hospital nothing was noticed except
that she presented a somewhat unstable but rather depressed mood
and that she referred many harmless observations of her neighbors
to herself, in the same way as formerly. When the wounds were
nearly healed she came to Burgholzli on the 16th of December, 1898.
Here she behaved in an orderly manner. She worked industriously
from the beginning but held to her ideas unchanged, which even
though they did recede at times, soon came into the foreground again.
 88

Besides taking care of all possible affairs in the house the patient
began to copy medico-legal opinions in an exemplary way, later she
was charged with the care of the copying, registration and similar
affairs in the physicians' office and became almost indispensable. For
two years she was my private secretary and took care of my associa-
tion business and several accounts. Every thing went along excel-
lently except when she had been to church or had made a visit to her
home, or when in other ways she was more occupied with her
delusions, she made some mistakes which she strove to correct.
Finally it happened that some of my relatives became connected with
her system of delusions and after that she was constantly stirred up.
She now, with short interruptions, does very well on the wards and in
the office; she has the keys and enjoys more trust than many
employees.
Even if now and then she sees that she erred in her delusions of
reference she holds to her system of delusions. She thinks that her
uncle and cousins consider her partly accountable for the family
quarrel, that through her indecision she was the cause of the poor
business after the death of the peddler. The cousins seized this
moment to take revenge on her. Others thought evil of her and took
joy in her ruin. All these enemies had formed a league. They had
informed the preacher in every place where she went to church so
that he could always say something in his sermon which was meant
for her, and tell her how unfortunate she will be or how she had
neglected this or that thing which could have helped her. Even in
the institution the director and physicians were in league with her
persecutors. I, for example, alwa)^s informed the preacher and other

enemies, by letter or by telephone and telegraph, when she went to

church. I also informed the nursing force of every thing she did, so
that the}' made, indirectly, scornful and blameful remarks. I do not
belong to her particular enemies but I will punish her because she
had made so many mistakes, and she deserves this punishment. To
be sure I have often promised her that I would help her all I could,
but would be easy for me to procure her a position in which at
it

least she could earn her living, but now it is too late; she has thrown
my help away and she is not worthy of it.
So far as the delusions are not concerned, or when they are more in
the background, her emotional state is a perfectly normal one. Joy
in beautiful things, love for her mother, gratefulness (even towards
me are preserved. The intelligence is above trie average. She pre-
|

serves interest in other things ; she makes diagnoses, comdemns the

idea of dementia praecox because it is She is, except
too broad, etc.
for the delusions, and partly also with them, more unassuming than
many normal persons. She underestimates her work. Comprehen-
sion, apperception, is normal in every way. Things, situations are no
different to her than before the beginning of her illness. Only in
her delusions does she show anything that could be so conceived.
 89

But, according to the self-observation of the patient, this does not cor-
rectly express it former condition. And I lay
as contrasted to her
great stress on her introspection. For in spite of all the patient has
retained a great objectivity in regard to her disease. She knows
very well that we regard her ideas a's morbid, and one can talk to her
about her delusions as one could to a third person. In her relatively
good periods she considers herself insane and recognizes in principle
that her ideas of reference are pathological, although in specific in-
stances, which are the most important at the time, she persists in the
correctness of her interpretation or, as she thinks, her observations.
She may also calmly state that she has corrected this or that idea. If
one calls attention to the fact that the present delusions are exactly
the same she may say that they are yet too fresh but that perhaps in a
few years it will be possible for her to see the matter in a different
light. Nevertheless she discusses the paranoia of others and tries to
prove to me that her case is entirely different because her ideas are
based on facts. ask her what reason she has to think I would take
If I
so much her when no one is better able than she to
troiible to injure
appreciate how I must take care of my time and money, this makes no
impression, although she can not give me any plausible grounds. It
is just as she says, I wish to punish her. She needs no further reasons.
The objection that I can not act as she thinks I do does not exist for her.
There is no delusion of grandeur behind these unreasonable imputa-
tions which she ascribes to me, and she does not draw "the conclusions
which might be regarded as grandiose ideas and which to the normal
might seem natural consequences of such a situation.
As an illustration of how far the ideas of reference go with this
patient I will give some other examples,
In the beginning of her illness the preacher said in a sermon since :
'
'

New Year the idea has not left me plow anew, do not sow under the
'

thorns' ". Soon after, in a carnival celebration, the picture of the

jumping pig was displayed with the label "Debut of the celebrated
equestrienne, Miss Thome. She was certain that the people had un-
'

'

derstood the allusion of the preacher. The pig is an allusion to the

fact that she is untidy.
The supervisor comes into the office whistling. Delusion the :

Director will send her away. The people know it and are glad.
A stranger comes to the house and yawns. He had given her to
understand that she was idling away her time and now must be sent
away.
"While she was yet at home she read in a newspaper that a girl in
Basel had fallen down the steps. Delusion the reporter would give
:

her to understand that in her former position she had not cleaned
the steps well.

The patient's heredity is not bad. Intellectually and

affectively she is above the average. If she had been a
 90

man she would have had a good chance to succeed. Since

puberty she has lived with well situated relatives. The
illness and death of her father as well as the economical,
not stingy, sense of her mother, early turned her ideas to
income and position in life. She wanted to make some-
thing of herself and she had a right to this on account of
her gifts. On this account the sexuality had to play a
minor part. Although she was sexually normal and was a
prett}' girl she never earnestly thought of marriage because,
as she herself said, her social levelwas below that of the
man who would correspond to her wishes. Fate had bound
her to an occupation which overtaxed her but did not give
play to her mental faculties. She could not get away from
it because it provided for her and her mother, and they were
able to lay by a little mone37 every year. Thus mentally
and physically this occupation filled her entire life.

The sickness and death of the peddler caused difficulties

which although in her fright were overestimated were not
entirely groundless. In her anxiety she was not able to
see every thing clearly. The certain existence which, ac-
cording to human reckoning, the shop had made for her,
appeared to her to be precarious. Her own ability, on
which she had secretly placed a good deal of hope,
appeared insufficient to cope with the situation. She must
come to misery. Up to here there was nothing that could
not appear to a normal person in a similar situation. The
only difference is that a normal person, after the situation
was straightened out and after the affect has passed awa} r
,

would correct the false ideas. The patient was not able to
do this. The chief reason for this we do not know. There
are, however, some other factors which certainly renders
correction more difficult, because they give rise to renewed
affects.
In the first place there was the relation to the rich
relatives,which often plays a great role in normal and ab-
normal cases. Here it is important in various ways. Some-
thing like envy of those who have reached the goal toward
which she was striving could not be lacking, although on
account of the faultless character of the girl it has
 t

91

probably remained unconscious. Then these relatives were

the ones who could help her if they would. They have
really done much, have given her pecuniary aid,* but the}' -

can not make the two women rich without injuring them-
selves. Then them
also the former close business relation to
plays a great role. The had got along very well but
patient
had to give place to a young wife. I have no reason to
think that she thought of marrying into the better position,
but every girl would have thought of it and the patient
probably did not leave the place without some bitterness.
She lived in that house a second time and again under cir-
cumstances which must have aroused her emotions, namely,
during the dissatisfaction in the famity where she felt her-
self between hammer and anvil, and where she saw how
people who were near to her quarreled among themselves.
The fact that she had to witness this without being able to
help caused her to make a certain self-examination : would
she not have been able to help? or was she by reason of
her presence a party to a quarrel? or did not the relatives
think that at least she might be partly responsible for the
trouble ? All these things have fastened themselves in her
mind, and as she felt things getting uncertain, her thoughts
were naturally turned to her relations because they were
the ones from whom alone help might come. Never in
her life had she injured any one, and these relations at
the most could only imagine that they had been injured by
her. And then when she heard some one say that there
would come a time for retribution (to her J it was clear to
her that these people had a reason, even if only an imagin-
ary one, to withdraw their assistance and indeed to actively
persecute her.
A second important factor lies in the fact that in the retired
life of the patient, her separation from the people to whom she

*To this the patient who had copied my paper remarked that she herself
thought that Herr S. was indeed very good but that he only helped her brother-
She expressed her opinion of this to him quite openly. " At such a time it was
clear to me that I was wrong. Shortly afterwards, however, I thought my
former opinion was right."
t Addition of the patient " Neither when I was with my uncle nor at an} other
7

time in my life have I thought of bettering myself by marrying. I always

thought that that was impossible and I never really considered it. My ideal
was to have an old maid's establishment in independent circumstances."
 92

belonged, a certain feeling of estrangement toward the en-

vironment, conscious or unconscious, could not be lacking.
People always act toward such a person in a different way
than toward an ordinary person. If she is unfortunate the
people who have always regarded her as peculiar, must
have a certain malicious joy. From this comes first the
fear that the people in the town do not begrudge her mis-
fortune, then the idea that the}' help to increase her mis-
fortune by allusions and calumnies.
The exact observation of the objective and subjective rela-
tions at the timeof the origin of the disease shows us therefore
nothing more tha?i the appearance of errors, such as occur to
normal persofis tinder analogous affects and a connection of
accidental occurrences to a thought complex which is kept con-
tinually awake by affects and her own trends of thought, just as
it is in a corresponding normal mental processes. The patho-
logical feature is only the fixation of the error so that it

becomes a delusion, and then the further extension of the delu-

sions so that it finally becomes paranoia. Whether the fixation
and extension of the error is determined by a special innate
or temporary disposition, by the coming together of many
important external factors, by a toxic action or by an an-
atomical change in the brain, is yet to be shown. But I
hold that at present there are no grounds to think that the
affects play an}' part other than that shown in the above
examples. Naturally I would not wish to say that further
experience may not demonstrate new relations of the affect-
ivity to the delusions.
But to my mind there is no question that the positive
part of my conception is correct and also that the affects in
this way symptoms. For
really determine pathological this
I would adduce the following unshakeable reasons :

The same mechanisms act even' da}' in the case of

1.

normal people in the way described, why not also with ab-
normal people ?

2. In the cases of paranoia which I have been able to

analyze in recent years (to be sure not very many) the
same cause for the direction and content of the delusions
could easily be proven. It was always through the affect-
 93

ively determined errors, which spring up in a way similar

to the dairy experiences of normal persons, and which are
then fixed and extended.
3. As Dr. Jung will soon show, the delusions and many
other mental s3^mptoms, perhaps I might say all, of dementia
praecox can be traced to the same action of complexes
associated with emotions.
Case II. Commercial clerk, born 1865. Father alcoholic, suicide.
No other hereditary taint. Normal child, somewhat retiring, be-
loved by his friends, appeared shy but considered himself a little
better than the others. Raised by his grandmother, who spoiled him
and gave him too much money. Attended the primary, secondary
and industrial -schools then three years apprenticeship in Italy where
;

he loafed, drank much and spent a great deal of his time with women.
Came home in a somewhat dilapidated condition. Worked eight
years very well in a telephone business. He drank quite a little but
was regarded temperate. Afterwards he was eight and one-half years
in a municipal office, where he performed his duties in an examplary
manner. He had to collect the taxes of a large village and was very
anxious about his work, and once in 1896 he had a surplus of 20 francs.
He thought that perhaps some one had placed the money there to test
his honesty, an idea which is not very uncommon among normal
people. He let the matter drop and thought no more of it. At the
end of the '90's he had a deficit of 50 francs which in spite of every
effort he could not explain and which the municipality silently
accepted. Nobody uttered a word of displeasure or blame.
In 1899 there was again a deficit of 40 francs. He could not bring
himself to tell any one about it and could not cover the loss with his
own money because he had used it all. Then the idea came to him to
record the tax of a person who was on a journey for seven months
instead of nine and use the surplus to cover the deficit. Discovery of
the irregularity was practically excluded. His conscience, however,
tormented him and he feared the discovery in some unusual way.
He was too intelligent to think that one would see the crime in his
face. Yet he thought it was possible to discover the traces of youthful
sins and debaucheries in the face. And he had committed debauch-
eries which he had regretted very much in the last twenty years. The
people would notice this and they could conclude that a man who had
behaved so badly in his youth would be able later to steal money en-
trusted to him. The jailer, with whom he often came in contact,
had, through his calling, the tendency to ferret out every thing. He
had what the patient had done earlier and had
also brought out
spread it abroad. Every one knew it, they looked upon him peculiarly
and smiled at him without reason. In the newspaper he saw a con-
tribution signed S. M. which referred to him.
, These letters meant
 94

-'
Saumensc/i." The new municipal-secretary wished him out of the
"way. Perhaps some one had taken the money in order to test him
and he had stood the test badly. He thought the people even-where
talked of things which related to him.
Xow he understood many past things which at the time had not
impressed him. He saw by many indications that they had wanted
to test him for a long time, etc.
Finally he could stand it no longer. He had worked very hard
(actually) of late and resigned his position and received an excellent
testimonial. He then was under treatment for several months but
scarcely improved. Then he took a position in the French part of
Switzerland but could not stand it there very long. They made
allusions about him even-where, it was as if every clerk knew of my
'

'

former life. '

He went to the Canton of Zug where he remained a
'

year, then left there in a rather dilapidated condition. He had drunk

rather immoderately while there in order to deaden his sorrows but
even in the inns the}* made allusions about him. They even began to
accuse him of crimes reported in the newspapers. He went to the
police and demanded investigation, saying that he had committed one
crime which he had reported to his superiors before he went away,
and that he was innocent of all the rest.
Thus on the 12th of November, 1908, he came to Burgholzli. He
bad a fairly marked tremor, had a slight lisp, and on stronger emo-
tions he stuttered, otherwise there was nothing somatically abnormal.
He related his sufferings in a perfectly clear manner; anxious,
modest, he had almost a cringing manner. He rapidly improved
mentally and physically in the institution where he felt safe. He
worked industriously and skilfully arranging statistics and the like.
"When he had no writing to do he busied himself on the farm. His
delusions, however, remained unshakeable. On the 16th of December,
1903, he was paroled. He was going to work in the business of a
relative. Three days later he voluntarily returned, saying the per-
secutions had been resumed and then his behavior remained the
same. He said that the rich relative who had taken him away and
who had brought him up and even now looked after him in an un-
selfish manner, was a pederast, that he had knowledge that the patient
knew this and so must also have an interest in getting rid of
him. The intrigues in part came from him. Probably he, the
relative, himself had also set fire to his barn which had recently
burned down. The patient now recollected that eighteen years
previously he had stood at the deathbed of a woman who was very
dear to him. There was also another woman there who hated the
sick woman and this woman had looked at the physician meaningly
and had then given the sick woman something whereupon she
died. Xow he knew that the woman had been poisoned. The patient
gradually became quieter in that, as he said, he would wait until he
was taken before a judge or was accused directly. On the 22d of
 95

April, 1904, he was discharged. Since then he has remained ab-

stainer and has worked industriously in his new place until the
factor}^ burned down. He had even, for the first time in his life,
saved money. February 24, 1905, he presented himself here. The
delusions had become much milder, in certain cases he admitted that
he had erred, in others he accepted the possibility of a mistake. As
one declared incompetent he had much trouble in finding- another
place. Perhaps this is the reason why it went worse with him a few
weeks later. Recommitment was spoken of but it was not necessary.
Since spring- we have heard nothing of him.
In the whole course of the disease there have been no hallucinations
or illusions.

A boy, fairly well developed intellectually, tainted by an

alcoholic heredity on the father's side, comparatively weak-
bad surround-
willed so that he loses control of himself in
ings,somewhat spoiled b3 his grandmother. In a foreign
r

country he had committed alcoholic and sexual excesses

which he had afterwards regretted. He then worked well
for seventeen years even he did indulge in the customary
if

drink habit. He was by his neighbors and

well liked
was regarded as reliable. A deficit in his cash account,
of which he was probably not guilty, caused him to con-
ceal it in a criminal fashion. There was a certain regret
over this fact and the old self reproof over his life in
Italy was renewed. The latter gives occasion for ideas of
reference which are not infrequent in normal people, but in
this case they can not be corrected. Paranoia is established.
Another set of delusions is formed about the complex of the
rich relative who had not earnestly helped him and who now
should look after his affairs. He must have some reason to
treat him in this manner. He is therefore also a criminal.*
An old erotic complex, which seemed to have disappeared
with the death of his sweetheart is finally connected with
the delusions and is expressed in the poisoning story.
We therefore see in this case also the normal expression
which the
of the affectivity leading to definite delusions, in
errors,formed in the usual way, can not be corrected and
at the same time increase, the latter, to be sure, under
the influence of the continuing domination of the same
affects.

* A hebephrenic whom we have recently seen in a medico-legal examination

had formed almost identical delusions about his rich relative.
 96

Case III. Machine-engineer, born 1855. Father and grandfather

on the father's side alcoholic. Bodily a well-developed handsome man.
As a boy he was capable, cheerful, but somewhat sensitive and seclu-
sive. Studied and worked five years in a large machine factory and
then went abroad. His brother wished to go to the Cape of Good Hope
and traveled to Marseilles in the hope of finding a ship and on
the way he met the patient. The latter also wished to go but stipu-
lated in a cautious way that the brother should secure places on the
ship in Marseilles and then notify him to join him. On notice
from the brother he went there only to learn that the latter had made
a mistake and that Marseilles was not a good shipping point for the
Cape. He then worked in Geneva and in England and in 1876 he
came back to Switzerland to perfect himself theoretically in a techni-
cal school. He had high ambitions and although he could expect
only a little wealth he thought of making himself famous, of making
an invention, and of having a factory of his own. He hoped "soon
to have money enough for that.
'
In the last Semester he exhibed a
'

drawing in the hope of obtaining recognition but no one noticed it

as he had expected. After that he thought that the teachers were
envious of him, especially after he had won a wreath at the shooting-
match.
Now his troubles began.He left school and found a place in the
factory where he had formerly worked. However, he thought he
was too good to work eleven hours a day for others and concluded
that the firm wished to use his intelligence and his discoveries,
for their own benefit. He went to England but felt that the firm
followed him there and taunted him with the fact that he had come
from "the riff-raff." From now on he traveled restlessly in America
and England, now and then making a visit to his own home. He
found everywhere that he was slandered and hindered in his work.
This seemed to be a question of delusions of reference, but he prob-
ably also heard voices. He had married in America but had left his
wife and allowed her to obtain a divorce. In the middle of 1890 he
had an attack probably due to a slight apoplexy (syphilis not
demonstrable). In 1897 he was at work in Zurich. Although his
employers were pleased with his work (he constructed independ-
ently) he thought he was persecuted by his superiors, that these had
formed a plot against him and that he was insulted in the cafes
and even slandered by persons outside of his windows. The patient
resigned his position and did not immediately find another. He
became more and more persecuted and began to drink, against his
custom. He became confused, surely had hallucinations at this time,
and finally in despair shot his persecutor from ambush.
Since then he has been in Burgholzli. He regards himself as an
excellent engineer who would have made many inventions if he had
only been left alone. He has invented a special machine for making
cogwheels of every kind which is practical. But he goes further.
 97

He claims that years ago he had denied that he regarded himself as

a statesman, a lawgiver or a founder of religion. The voices or the
ideas of reference evidently had referred to this, but he now says they
were correct, for before the catastrophe he had drawn up laws for a
colony, a la Freiland, which were not unreasonable and only suffered
from the ordinary mistakes of the best of such schemes for world-
happiness.
In the institution his system of delusions did not extend. Only
now and then he complained that some one had accused him of uran-
ism. Hallucinations were not demonstrated with certainty, at any
rate they were subordinate. He grumbled continually about his dis-
charge, said that he had murdered his superior on account of his
persecutions and that he had regained his reason immediately after
the deed. He learned Spanish and Russian so that he could get a
position in another country as soon as he was released. He also
took care of the institution printing-press, but had almost always
to be urged to work.
Once while walking he escaped but did not receive money from his
relatives, as he had hoped, and finally came back from France. He
did not have the energ}' to live without his passport. Leaving his
delusions and the reactions to them out of consideration nothing can
be observed as a symptom of a mental disease.

In this case we can not follow the development of the

paranoia. Yet it is very easy to find the root of the delu-
sions. The patient was capable and his intelligence war-
ranted the most beautiful hopes. He had the highest
ambitions. In opposition to this, however, stands a char-
acter which lacks energy and he is handicapped by a great
sensitiveness. Thus we see the young man make up his
mind to go to the Cape when he saw his brother going there
and then abandon the trip on account of some small diffi-
culties. We see him at once greatly disappointed when a
drawing did not receive the recognition he had expected.
In the asylum he must be urged to work and when he had
escaped he did not have the strength to maintain himself.
With the exception of the criminal act which he committed
in a state of temporary confusion, his reactions to the per-
secutions were nothing but a continual cowardly flight.
Thus it is easil) understood that he could not accomplish
r

wT hat he wished. Since he was sensitive, grounds were

not lacking for the feeling that he was being injured by other
men and for ascribing to these his failures. And, since
the abyss between the wish and its accomplishment always
remained, these ideas were continually maintained, and the
patient became paranoic.
Case IV. Bookbinder, married, bom 1869. Father irascible, an
older sister temporarily insane, another sister a liar and a thief, a
step-brother by the same father had been convicted of some crime
and had died in an insane asylum. Was always a dullard and in
school had to attend one class two years. Later, onanist. In earlier
years he had frequent headaches and at one time had to enter a hos-
pital on this account. Always somewhat irritable, irascible, some-
times struck his wife, but afterwards apologized. Always anxious,
modest, shy.
Since the latter part of the 80's he lived with a catholic common
law wife. Since he was an orthodox protestant he finally concluded
about 1892 to marry her, but afterwards continually regretted it. He
felt especially guilty toward the minister of his church who had con-
firmed him and to whom he went every Sunday to church, because
he had not asked his advice and feared him on this account. Two
years after his marriage he once passed the minister (who dominates
his parishioners and is a master in religious suggestion), but
did not recognize him until he had passed, then took off his
hat but believed that it had been too late for the minister to see.
Now he was in despair that the minister would be offended. Soon
it seemed to him that his fellow-workers knew that, acted differ-

ently toward him than formerly and laughed at him. He also

thought that his employers would not advance hiiu on that account.
He remained discontented and changed his position several times.
It was not until six years later, 1900, on the occasion of a similar
circumstance that he became worse. He was speaking one day v/ith
a fellow-workman about leaving his position and just then his em-
ployer came into the room. In his fright he forgot to greet him.
Now he was scared lest his employer would be offended. He
received, as he believed, harder work and was blamed more. His
fellow-workmen noticed that he was not considered so well and began
to annoy him. He made up his mind he would never again fail to
greet anyone. From caution he began to greet strangers. He
believed that every one noticed whether he greeted them or not, and
finally that his coming was telephoned to the passers-by. In
the course of the next two years this became worse and worse.
He imagined that the people did not hear his greeting and there-
fore he became more insistent and would greet the same persons
several times, and run after them to repeat it. He now began to
greet his wife and would say to her in the morning on awakening,
with gradually increasing repetitions, "Good morning, Mrs. Meyer."
He himself began to think his acts were foolish, but since he was con-
vinced that he must greet people he began to think that God had
 99

imposed the greeting-dtity on him in order to punish him for his

sins, the onanism, the marriage without consulting the minister, and
especially the neglect to honor his superiors. The first two reasons
were rarely and only incidentally mentioned. He could only think of
his duty to greet, he neglected his work and sat for hours on the sofa
thinking of his misery. He became more irritable toward his wife
and occasionally threw things at her. Since he had expressed ideas
of suicide he was brought to Burgholzli on the 8th of September,
1903. Here he showed himself as a timid, excessively modest, unener-
getic man. He wept much. One time when he had two pollutions
he was very much depressed. He had before entrance received
very unnecessary treatment for spermatorrhoea. Quite apart from
his greetings he always apologized for something. He excused
himself for mistakes which he thought he might have made but
did not remember having made. He even took the part of other
patients who, irritated at his continual greetings and hand-shakings,
would give him a box on the ear, and he regarded all his suffering
as the deserved punishment by the Almighty. He thought he was
insolent when he said that he had learned the bookbinder's trade
or that he was a bookbinder. On one occasion he said that we should
tell him what he should do and he would certainly do what we wished.

It was not possible, however, to repress his persistent greetings

even though he had promised dozens of times to curb them. He
thought that we and God desired it of him. When he saw four
buttons somewhere he thought that it meant that he should now
greet every one four times. Once he thought that it would be enough
if he greeted a few times less than it had been shown to him, but he

was unhappy afterwards because he had not obeyed God.

Since he had also expressed the idea of suicide here it was quite
difficult to place him properly. He had to be kept where he could be
watched with the other patients and then he did nothing but greet
them. It was quite impossible to always protect him from their
blows. If he was kept alone in a room he worked industriously,
sewed and did simple copying quite well.
On the street he had often thought that some one said here he
'
'

comes." Excepting this there were no traces of hallucinations or

illusions. The affects were always entirely adequate to the con-
lent of thought and also qualitatively were not be}rond normal
limits. Blocking, the feeling that his thoughts were taken away,
sterotypies or other signs of dementia prascox could not be found,
although naturally they were zealously sought for. His system of
delusions, in spite of its foolishness, was built up quite logically and
consistently. He himself recognized the foolishness of the greetings
but since other men and God wished it he resigned himself to this
fact.
In the institution he also showed some ideas of reference besides
his chief idea. He thought, for example, that when an attendant left
 100

was on his account. He heard some one say, there we have

'
•

that it '

it again." That was a reference to his pride. If an untidy patient

was cleaned he felt that in some way he was concerned.
He gradually pulled himself together and could be taken home
occasionally to see how he got along and was, on April 6, 1904, defin-
itely discharged. At home, after a short time, the old trouble
recurred. He especially annoyed his wife by continually greeting
people who came into the shop and in that way drove them away.
From December 13, 1904, till May 14, 1905, he had to be kept in the
institution and since then he can, with difficulty, live with his family.

In this case the diagnosis is not so plain as in the

other cases. The continual greeting' looks very much like a
stereotypy. can be easily differentiated from the
But it

stereotypies of dementia praecox. It does not represent an

abbreviated action of emotional value which is more or less

unconsciously and automatically performed even when the
reason for it is no longer present. The act remains, from
first to last perfectly conscious in all its parts, in its motives
and its execution. It is the logical consequence of a delu-
sion, and if the latter be assumed a normal man would act
in the same way as the patient. Through its premises it
is as well founded as the fact that a person in a high

position must, on every drive through the town, answer the

greetings of the public.
The impression of stupidity which the behavior of the
patient causes is not so easy to connect with a simple par-

anoia. The picture reminds one very much of the foolish

acts of a hebephrenic. Yet I would like to emphasize the
fact that this can also be explained on other grounds:
The was never very intelligent. In the public
patient
schools he had to attend the same class twice. His whole
behavior bears the stamp of heaviness and thick-headedness.
The continual greeting is not so perverse, for one of his
intelligence, as it would be in an intelligent man. To this
must be added the fact that the patient knows the foolish-
ness of his acts; only, according to his logic, which in this
case is correct, it is not the greetings themselves which are
foolish, but the fact that God and other men require such
a thing of him. We must not forget that occasionally God
requires from intelligent people, acts which to us appear
just as senseless, as, for example, that a pilgrim must crawl
 101

on knees from the spot where he sees the church

his
church of the place of pilgrimage
steeple to the Compulsive .

acts which are no more intelligent and yet often are seen
in very intelligent persons must also be remembered.*
I do not believe, therefore, that one has any right in this
case to conclude that the patient is deteriorated, because an
individual act, though frequently repeated, gives one the
impression of dementia. If we add that after a rather long
observation, we have not found the slightest sign of demen-
tia praecox, the probability of the presence of this disease
is practically nil. Nevertheless, the thought can not be
totalby repressed that it is a case in which the signs of
dementia praecox may manifest themselves later or that
they are now masked by the continual monotonous act.
Since, however, the mechanisms of the formation of delu-
sions in dementia praecox are the same as we think we have
shown above in paranoia, and since they also accountfor
many errors of normal persons, the example is nevertheless
instructive.
A slightly imbecile, very shy, obsequious and at the same
time deeply religious man is by the power of love brought to
marry a woman of another faith. He regrets it for years but
can not leave his wife. The minister who had confirmed him
and with whom he had remained in contact, the represent-
ative of the heavenly anger, is a mighty personality. Before
his marriage he had always had the feeling that he should
ask this man's advice but he had never dared approach him
with such a question. He passed this man without greeting
him and the fact that he had done so weighed like sin on his
mind. At this time the patient may have concluded to
take care that it should not happen again, and he probably
felt a tendenc}* to greet too much rather than too little.

At any rate, several years later a similar incident happened

again. it was not his heavenly but this earthly
This time
salvation that was concerned. He neglected to greet his
employer just as he was speaking of changing his position.
He was dependent on this man who could injure him by
* Naturally it can not be a compulsive act in this case. The patient is as
-convinced of the correctness of his premises as only a paranoic can be.
-Moreover, the general delusions of reference exceed what is found in obsessions
-and it is all built up as a logical system.
 102

giving' him a bad recommendation. It is characteristic for

the weakness of the patient that he did not leave the place
but stayed and allowed himself, as he thought, to be tor-
mented by his employer and fellow- workmen. Therefore,
the anxious affect is continually fed and the patient can
not be free from it any more, and the delusions have time
to fix themselves. The disease becomes incurable.

In these examples a complex of ideas associated with emo-

tionsforms the point of departure for the delusions and'
perhaps for paranoia. This view differs but little in prin-
ciple from Wernicke's conception of "over-valued ideas."
A lies in the fact that Wernicke does not
small difference
sharply separate the paranoic disease-picture with its pro-
gressive development of a delusional system from other
kinds of over-valued ideas. A greater difference is brought
about by his anatomico-physiological conceptions according
to which the molecular changes are greater in perceptions
associated with affects than in ordinary ones, and according
to which disorders and other changes in the psychokym are
adduced as explanations.* We prefer to remain in the
sphere of psychological facts since the physiological pro-
cesses are too little known and since such hypotheses are
too much in the air.
But we believe that we differ most from Wernicke in that
this author places the affect-full occurrences almost alone
in the foreground, while we place beside this a series of
lasting predisposing factors, such as we have observed in
our cases, as absolutely necessary. But even with these
causes we believe we are yet far from our goal. We
are, on the contrary, convinced that in the majority of the
cases further investigations will show a constitutional predis-
position, and a chain of Freud's predisposing occu?'rences.
The constitutional predisposition will explain why these
people and not others suffer from paranoia and Freud's
complexes will tell us why the critical events have brought

* Compare P£eifer—Monatsc/ir. f. Neurologic and Psychiatrie XIX. p. jo, bo..

6s-
 103

out the paranoia, and eventually, why the developed para-

noia immediately connects itself with these events.
Similar processes are very frequent with healthy indi-
viduals. If we are anxious for any reason a mass of percep-
tions and other occurrences are interpreted in the sense of
the affect. In a merry mood we take everything lightly and
often notice only the agreeable and thus deceive ourselves
as to the real situation. In the same way the melancholic,
in whom the pleasureable associations are inhibited by the
depressive affect, uses only those ideas which correspond to
the depressive affect. Thus errors arise in the more pro-
nounced states of this sort which can not be corrected so
long as the affects inhibit the opposing ideas, i. e., so long as
the disease remains at its height. That is indeed the most
important origin of the depressive delusions.
In these examples it is a question of a general emotional
state of some duration such as elation or depression. But an
affect which is connected with a special idea complex, may
have a like action if it frequently or persistently stands in the
foreground. Then the new experiences are associated with
it just, as in the other cases, they are associated with the
exalted or depressive ideas and, moreover, further associa-
tions are so regulated that those in harmony with the affect
are facilitatedand the opposite are inhibited. This leads
to errors in the normal and to delusions in the abnormal.
The ground for the domination of a complex may be
physiological or pathological.
On one occasion, was reading, I had an intel-
when I

lectual feeling that I saw my name two lines below. To

my astonishment I found only the word " Blutkorperchen."
Of many thousands of mistakes in reading in the central as
well as in the peripheral field of vision this is the worst case.
Usually when I thought
I had seen my name the word which
had given occasion for the mistake was much more like it
than this. Generally almost all the letters of my name had
to be present before I would make such a mistake. In this
case the reason of the 'delusion of reference' and the illusion
'
'

was easy to trace. I was reading the last part of an article

about a kind of bad style in scientific works from which I
 104

did not feel that I was entirely free. —A student, during- his
examinations, received an invitation to dinner from one of
his teachers. The latter, as I can bear witness, wrote a
totally illegible hand andthis caused the anxious student
to read instead of an invitation to dinner, a notice that he
—
had failed in his examination. A colleague who is a good
psychological observer said once, that according to his
own experience and observation of his fellow-students,
every candidate for examination suffered from delusions of
reference toward his examiner. —
A woman student, an
otherwise very clever girl, was frightened, during the ex-
amination time, by every man who wore spectacles, because
she thought he might be an examiner. A father whose —
absent child was ill thought that every telegram contained
bad news, although he daily received business telegrams.
Bvery complex accompanied by has normally
affects
the tendency to gather about it new This
experiences.
tendency to association must be due to the fact that such
complexes occupy us much longer, that the}' are more
often and more persistently in consciousness than others,
and therefore furnish greater chances for association. The
affect itself increases this tendency by inhibiting associa-
tions which are contradictor}7 thus interfering with object-
,

ive judgment while it emphasizes and gives greater weight

to those which are similar or can be construed to be in accord
with the complex. Thus the examination candidate, at the
critical time, only thought of failing, and it is easily under-
stood that when he received a letter he supposed that it con-
tained a notice of his failure. His anxiety caused him to read
in the scrawl of the examiner the dreaded catastrophe, exactly
as a fearful person regards a stump of a tree as a robber.
Similar delusions of reference are very frequent in melan-
cholia.
Our paranoics were in the same condition at the time of
the formation of their delusions. The conclusion that the
development of paranoic delusions is essentially the same
as the formation of errors in normal people is therefore
warranted. For their genetic explanation we need no other
mechanism than that which we alreadv know as the mode
 105

of action of the affects. We must especially deny the necessity

of assuming in addition an affect of suspiciousness, a disorder
.of the apperception, or similar hypothetical constructions.
But in this way only is the origin of the delusions rendered
clear, not the genesis of paranoia. For if we ask ourselves
what is the intrinsic nature of paranoia we can give no answer,
but I think that no answer is better than a false one. Thus
we must yet ask why, in certain cases, an idea accompanied
by affects becomes the starting point of paranoia; why the
errors caused by affects are corrected in most of the other
cases but not here why they extend in paranoia whereas
;

in normal people, although they may not be corrected, they

do not increase;* and finally what causes the inability of
correction and the tendency to extension of paranoia.
We can cover our lack of knowledge by the word dis- '

'

position." With the same physical and mental trauma

one person develops an incurable psychosis, another a
transient hysteria, another a momenta^ fright. Wherein
lies the difference ? The nervous system of one person re-
acts to the traumata in an entirely different manner than
does that of another person. Moreover, some accidental
influence, fatigue, poor nutrition, may alter the disposition
momentarily. Or ideas which, during some accident, happen
to dominate the patient may predispose him to the elabora-
tion of the impressions in a pathological sense. All these
possibilities must be taken into consideration.

* It not infrequently happens that under the influence of an affect errors are
not only made but fixed in healthy people. The errors, or we might say, delu-
sions can not then be differentiated from the false or insufficiently founded ideas
of the different kinds of superstitution which are produced by suggestion. The
difference from paranoia is that they do not extend. Thus they rarely have
much influence on the actions of the individual. Sometimes, however, they
dominate the thoughts to such an extent that one must regard them as patholog-
ical. The following case is interesting, though we are dealing with an
acquired emotional disposition. A high state official in the revolution at the
time of Napoleon remained true to his sovereign while all his colleagues forgot
their oaths and turned toward the new sun. He was therefore imprisoned.
After the restoration he was completely forgotten. His unprincipled col-
leagues were ashamed of their actions and therefore hindered the revision of
his sentence. After about twenty-five years his family succeeded in getting
him free. He appeared, as a rule, to be normal. The miserable wrong which
had ruined his life had, however, not passed over him without leaving a trace.
From time to time he fell into attacks of rage which could only be cut short by
all his family assembling as soon as possible and begging his pardon on their
knees it was not necessary for them to give any reason for their apologies.
;
 106

For the majority of psychiatrists the question of disposi-

tion in paranoia is already settled. For them it is a matter
of an innate, generally, a family disposition. At present,
however, neither the personal nor the family disposition is
proven. More than one case of paranoia in the same
family is rare. I know of no general disposition that is

necessary for the origin of paranoia. Xaturally psycho-

pathic families are more inclined to ps3r choses but not partic-
ularly to paranoia. Many speak of " degeneracy, " yet this
again is not definite, but comprises several concepts which
are not well circumscribed. As opposed to this we must
insist that in paranoia " degeneracy, " even if existing, can
not be the same as that of idiocy or imbecilit\'. In these
conditions (the latter at least consists of many etiological
groups) we have, besides the poor mental development,
also a tendency to bodily defects. The so-called signs of
degeneracy are found nowhere so frequently as in epilepsy
and idiocy. It is entirely different in the case of paranoia.
The majority of cases consist of men who are bodily and
intellectually well developed. Among the paranoics which
I have seen there few who could be called bodily
are very
or mentally degenerate. There were, as far as I can judge,
"•

more well developed individuals among them than among

the normal.
The disposition to paranoia is therefore yet to be dis-
covered.
If it is a psychological one, it naturally does not need to
be a definite one, for in such a complicated mechanism as
the mind, most results can probably be reached along
different lines. If we assume that certain emotional dispo-
sitions such as we have found in the first three cases, lead
more easily than others to a certain conflict with fate, then
this may furnish one of the most important of the predispos-
ing causes; just as the struggle for existence forms the most
common, but not the only ground from which a certain,
indeed the most frequent, group of traumatic psychoses
spring. The struggle with fate, as the diversity of the
three examples may may
be determined by different
show,
combinations of types of emotional tendencies and char-
 107

acter. Even the influences of external occurrences may

be lacking or may be very important, for usually (always?)
a psychic trauma is necessary for the development of para-
noia, such as the death of the peddler (Case I) or remorse
(Case II). Then there must be a reason why the delusion
is maintained and incurable, and perhaps also a reason

which causes it to gradually extend.*

These factors also, as far as we know, do not need to be
uniform. They may be different in every case, or may be
combinations of different causes. It would be possible, for
example, that in Case II the patient would not have
developed delusions of persecution if he had not had a bad
conscience on account of his onanism, which he thought
was discoverable in the face and therefore attracted atten-
tion. It must also be remembered that a serious experience
which produces a break in the individual's mental exist-
ence determines a lasting disposition exactly as in the
traumatic neurosis the struggle for existence continually
maintains the feeling of being ill. Both correspond to the
which according to Tiling, {Neurol. Psychiat.
vis a tergo,
Wochenschr 1901-2, pages 443-444), forces the thoughts in
.

a definite direction. Our first patient was constantly forced

to be dissatisfied with her position, she had to fear for years,
that she would lose the little which she had gained. Case
III always had to be discontented with whatever he accom-
plished or did. The fourth patient always felt oppressed
by his marriage and by the presence of his superiors, etct
Beside the innate functional disposition, I can not totally
exclude, in the originary paranoia, a superadded disease of
the sort of dementia praecox. Quite apart from the exten-
sion of the concept of paranoia outside of the Krsepelin

* Incorrectability is naturally not extension. A great many suggested errors

are incorrectable they do, however, not extend to other experiences and
;

therefore do not lead to paranoia.

tlf such psychic traumata alone produced paranoia it would be conceivable
that traumata of a certain strength could produce paranoia in a health y brain.
We would then seek in vain for a disposition in the stricter sense and even in
the cases where a mental weakness is enumerated among the causes of the dis-
order, this weakness would not be the determining factor. The possibility of
the existence of a monomania in the old sense could then not be excluded.
This is not the place to discuss the existence of monomanias and the over-
valued ideas which are contested with more feeling than proofs. Yet I can not
 108

school it is not improbable that a part of the cases grouped

by some as paranoics are hebephrenics in whom the disease
process has not gone so far, and I am not sure whether such
a thing could not happen to a faithful follower of Krsepelin.
The case of Schneider's* which Kraepelin himself recog-
nized as paranoia seems to me to be such a one. If in such
cases the diagnosis of dementia praecox is not made, the

disease process must be so

pronounced or so nearly-
little

healed that we, with our present methods, can not demon-
strate any specific signs of dementia praecox while the
further development or at least the extension of delusions
is yet possible.
Against the generalization of such an idea there is only
the fact that with caution one scarcely ever has to change
the diagnosis of a long -observed case of paranoia; while if
many cases of paranoia were non-advancing hebephrenics
it would frequently happen that a later progress would
manifest the dementia praecox. Nevertheless I desired to
call attention to the possibility because it shows us that

some anatomical or chemical changes might cause paranoia.

But in that .case we would have to assume that the process
would have be one that does not lower the general
to
intelligence, for if one does not make the absurdity of the
delusions the criterion for the general intelligence, one
finds in the genuine paranoic no mental weakness in any
mental operations which do not concern the system of de-
lusions. But to assume deterioration on account of some
absurd ideas is opposed to all experience. We only have
to remember what absurdities are committed and believed
in the religious and political spheres by very intelligent
people, or of the power of suggestion which ignores logic,
or of the absurdity of our dreams, etc.

avoid calling attention to the fact that it is inconsistent to deny the possibility
of such things, so long as we regard patients with hysteria or obsessions as not
insane. Therefore it seems to me that if the disposition which leads to hysteria
and obsessions does not appear important enough to cause one to think the
whole mind affected we have no more reason to regard the disposition to
paranoia as a general mental disorder. The most evident errors can be sug-
gested to healthy individuals and we have seen that the power of the affects is
identical with that of suggestion. Moreover, according to our present knowl-
edge, it is not excluded that paranoia can be produced by an accidental sugges-
tion or by an affect in people who can not otherwise be called mentally ill.
* AUgem. Zeitschrift. f. psych. Bd. 60, page 65.
 109

To be sure there is a kind of " dilapidation " in paranoia

but it is different from deterioration. It is the condition

which we find in all people who only think and act in one
direction. This is best illustrated in hospital residents who
on account of some bodily ailment hear and say the same
thing for years. It is also shown in people who outside
their occupation exercise their minds only at a favorite
table in the cafe, or in women with a one-sided or no occu-
pations. It forms an integral part of that which Moebius
designates by the name of " Physiological feeble-mindedness
of women."
Furthermore the energy of paranoics may diminish as in
other people, and they may then act differently than they
think or even speak. Or they may develop an atrophy of
the brain by which an easily recognized dementia senilis is
added to the paranoia. Moreover congenitally weak-
minded people may become paranoic and naturally remain
weak-minded, or a paranoic may at the same time be an
epileptic such cases are described though they do not
(

meet the newer demands of diagnosis and then an epileptic

)

dementia may be added to the paranoia. I have not seen

other forms of dementia in paranoia.
To the affective we must
also add the intellectual dis-
positions in paranoia which appears in some cases to be the
most important factor. A certain vagueness of thinking
must favor the origin of delusions. We especially expect
to find such defects at the bottom of the disease in paranoia
quaerulans and in megalomanias. I had to give testimony
in the case of a world-reformer who played a great role,
as far as the German tongue is heard. I was in doubt for a
long time which I should call him, a paranoic or an im-
becile. The confusion of his system of delusions which he
himself could not clearly grasp, as well as the confusion of
his ideas generally, caused me to place the intelligence-
defect in the foreground. The man presented a certain
system in his delusion of grandeur, but his writings clearly
showed that the indistinctness of the ideas together with a
very active temperament had given rise to the delusions.
Since the patient could not circumscribe his ideas it was
 110

possible for him to subordinate all that occurred to him to

the " principle of contrast" and on this, as well as other
vague ideas, he built his system.
In the case of the assassin of the Russian ambassador in
Bern, on the other hand, I felt justified in diagnosing para-
noia since he had built his delusion-system as consistently
as was possible with his vagueness of thought, for the vague-
ness was not, as in the first case, the cause of the delusions
so that the whole system was built up from such indefinite
concepts, but the indefinite concepts made it impossible for
the patient to sufficiently grasp the rights of others, which,
in turn, together with a marked affectivity gave rise to the
origin of the delusion of persecution. These were very
simple and could therefore be as clearly conceived as in the
—
case of other paranoics. We have in the asylum now a
paranoia quaerulans in whom the indistinctness of the
ideas clearly helped to form the delusions.

If we always find emotional complexes at the bottom of

paranoic delusions we must then be able to divide the different
kinds of the disease according to the different complexes.
While I am far from claiming that this can adequately be
done, the following remarks may nevertheless be of
interest.
The majority of persons wish to get ahead in life, but
even the most fortunate find many hindrances. Those
which lie in circumstances and not in persons must lead
either to resignation or to self-destruction when they are
insurmountable. Furthermore, difficulties which are not
caused by our fellow men do not arouse our feelings as
those which can be ascribed to some person.* When bad
weather interferes with an excursion we had planned we
are annoyed, but we seek some other pleasure. But if the
meanness of a rival is the cause of a disappointment, then
we are apt to get seriously angry. Thus the complex of
being ill-used can refer almost only to persons, and must

* Perhaps the obstacles which are within ourselves are felt the most e. g. the
;

conflict between high aims and insufficient energy, etc. (Corap. Case III).
 Ill

lead to delusions of persecution. This mode of origin

which we have assumed also explains why delusions of
persecution are the most frequent type seen in paranoia.
Every one who wishes to advance has opportunities of feel-
ing himself wronged.
As the opposite of the delusions of persecution are usually
regarded the delusions of grandeur; the contrast to the feel-
ing of being persecuted is the feeling of progress. Of course
the feeling of progress is viewed differently from the feeling
of being persecuted. The latter refers to opposition by
others, the former we ascribe to ourselves and to the help
of our own qualities. The true opposite to the delusion of
grandeur is the delusion of inferiority which we see in
depressive psychoses. In manic-depressive insanity the
delusions follow the oscillations of the affects and thus the
delusions of grandeur and of inferiority vary with the
emotional state.
The delusions of grandeur of paranoia are limited to a
few spheres. The paranoic scarcety ever fprms a bodily
delusion of grandeur,* as does the exalted paretic, and
within certain limits also, the simple manic. The paranoic
delusions of grandeur are also rare in the sphere of ordinary
competition. As our examples show, too great pretensions
in this direction lead to delusions of persecution through
the impossibility of fulfillment. But if the endeavor is in a
sphere where results need not appear at once, where the
essential part lies in the preparation, in the elaboration of
schemes or theories; if the ambition tends in the direction of
scientific, religious or political aims, then the real difficul-
ties which from the disbelief of others come only in
arise
the later stages, and the pleasure in such elaborations
may remain undisturbed for a long time.f It must, more-
over, not be forgotten that every one who does work of

* Compare hypochondria.
tThe number of, who spend all their lives defending
not paranoic, scholars
some youthful scientific mistake probably fairly great. This is the best
is
demonstration of how little the opposition is perceived. And the case is even
more glaring if the justification is expected in the world to come. Then one
may aim at the greatest nonsense in this world without the uncomfortable
feeling that one is making a fool of one's self. Perhaps the discovery of the
N-rays belongs here. Comp. Jahrbuch der Naturwissenschaft 1904-5, p. 50, f.
 112

this must expect opposition and have a certain

kind
pleasure in combatting it. For this reason these com-
plexes are not apt to call up delusions of grandeur. To
be sure, it lies in the nature of things, that even in such
individuals the false judgment of their own powers and of
the problems will eventually cause bitter disappointment.
Therefore we find that in megalomanics whose euphoria
does not entirely overshadow every thing, delusioirs of per-
secution are apt to be mixed with those of grandeur.
The idea of having the support of other persons is not
likely to develop into a complex in our sense. If the con-
viction is based on facts there is no occasion for delusive
imagination; if not, then the idea-complex must act in the

direction of a delusion of persecution, as is illustrated in

one of our cases by the delusions against the rich relatives.
Somewhat similar to the idea of having the support of
others is the idea of high descent which probably does
occur in pure paranoia. Here the patient very early gets
into conflict with reality and, therefore, such delusions
scarcely exist without ideas of persecution. I must confess,

however, that, in recent years, I have seen such ideas only

in paranoid dements. Perhaps this complex is rarer in our
democratic Switzerland than elsewhere.
The erotic complexes are among the most important.*
Thus the delusion of being loved is very frequent in
paranoics, generally to be sure, connected with social
ambitions so that the one who is loved or thought to be in
love is usually of a higher social level than the patient.
Naturally conflicts then also arise and a mixture with ideas
of persecution is very frequent.7
Those who are in sexual
relationship with one of the other sex, but who are un-
satisfied, develop as a result of their complex a paranoic
state with ideas of jealousy, which naturally is more fre-
quent in women than in men. Under many circumstances
jealousy is normal in a marriage relation without sexual
satisfaction. If the individual is too much dominated by
this complex which, of course, is associated with marked

* In the discussion of a point of view similar to ours Lomer (Neurol. Centralbl.

1905, p. 944) claims that the " briginare Verliebtheit " is analogous to paranoia.
 113

affects, the transition to delusions of paranoia is easily

understood.
Another very important complex for the civilized individ-
ual is that of bodily health. However, an over-rating of
health finds its own checks so that a delusion of this kind,
if it became too marked, would at once correct itself.

Nevertheless I wonder whether not many of the health fad-

dists, whom we often find as adepts of certain systems of
"Natural ways of living" are not suffering from a mild
paranoia, with the delusion of grandeur of especially good
health. But since such a condition is only possible in mild
forms, and then does not essentially interfere with adapta-
tion to the environment, it would only rarefy be observed by
psychiatrists.
The complex of bodily health becomes more important
when it makes itself felt in a negative sense, it leads then
to hypochondriasis. In my opinion it would be wise to
reserve this name for those cases which do not deteriorate
intellectuallyand which, without primary signs of exhaus-
tion, begin insidiously, show remissions but are essentially
progressive, in short, which behave in every way as par-
anoics with hypochondriacal delusion-systems. I do not

know why this disease, which is rare only in insane hos-

pitals, should not be regarded as paranoia. Unfortunately
I possess no observatious which covers a long enough space
of time and is exact enough to be used as proof. Never-
theless, I am willing to wait for objections to this view,
which is not entirely new,* though the paranoic hypo-
chondriac of the books are, as a rule, cases of dementia
praecox.
Except for its usually more acute beginning the trau-
matic neurosis (psychosis) in its most frequent incurable
depressive form is also closely related to, perhaps identical
with paranoia, because even if we assume the same mech-

* The psychogenic origin of hypochondriasis too has long been suspected

among others even by Romberg, who regards as the hypochondriacal element the
increase of the existing sensations and the excitation of new ones by means of
ideas. (Cited by Wollenberg,Centralbl. fur Nervenheilkunde uiid Psych. 15, VII,
1905).While many are inclined to lay stress on hyperesthesia of organs and
regard the direction of the attention as secondary I prefer to assume the
reverse.
 114

anism of origin, the struggle for indemnity which arises

suddenly would naturally produce a more rapid develop-
ment than the factors responsible for the typical paranoia
which act much more chronically and other ; acute psychi-
cal traumata may lead to the same clinical picture. We
have at present a very excellent instance of this kind in the
hospital ; I knew the patient before the disease began and
have been able to follow her case for years, although at
times only from a distance.

Nurse, born 1848. In addition to other sad experiences she has,

since 1872, been married to an alcoholic, jealous, rough husband who
ill-treated her. In 1876 she received news that her sister, who was
divorced from her husband, had become pregnant and had produced
an abortion, from the consequences of which she was dying. She her-
self had in former years allowed herself to be forced into sexual rela-
tionship with the sister's husband before his marriage, when he was
her guardian. Therefore when she received the news it occurred to
her that she was also indirectly guilty of the death of her sister. She
was afraid to go alone to see her sister but took her brother with her.
On her return from her sister's she met her husband, who as usual
began to torment her with his jealousy. On the ward she "did not
know what she was about. She said to another nurse that " If I
'
'

become sick, then just say that my husband is to blame." During

the night she had a chill, temp. 39.6 C, yet two days later she was
treated as a simple neurotic. Since then she has presented the typical
picture of a traumatic neurosis with terrible pain everywhere, with
inability to work for years, although on suitable mental treatment she
has had several remissions.
Traces of delusions of persecution by physicians and nurses who
would not help her and who paid no attention to her sufferings were
mixed with the picture, but such ideas were later corrected, and in
reality several physicians did regard her as essentially lazy and weak-
willed and treated her accordingly with the result, of course, that each
time she became worse.

The mechanism of origin seems clear. The husband

whom she hated must be guilty of her disease and the
blame would be greater if she was very ill and if the disease
ruined her whole existence. She was about in the same
mood as a child who could not get its father to buy it
gloves and then stubbornly says that "it would serve you
rightif I freeze my hands." But this is surely not all. The
throwing of the blame on the husband had a much more
 115

important source than mere hate. She thought then she

was be blame for the misfortune and death of her sister.
to
Since she was a very moral person (the sexual intercourse
with her brother-in-law was performed only after a great
moral conflict and forced from her by a threat of suicide)
the fact must have tormented her very much. Now her
sub-consciousness transferred this guilt to her husband.
Not she but her husband would then be to blame if she was
miserable. The accusation of another displaces the feeling
of one's own guilt. Such a transference in a way eases the
conscience as I have seen, many times in nurses and
attendants when they made mistakes.
A special form of paranoia is the' paranoia quaerulans.
For a long time it has been known that a real injustice is
often the occasion for the onset of the disease * and accord-
ing to Storring (Psychopath. 484) delusions of persecution
can also come from well-grounded suspicions. In these
cases the origin of the delusion, in the sense of our' con-
ception, is easily understood and it is not necessary to
again explain this. On the other hand it might be well to
refer to the fact that the constant attempt to get justice as
we find it in paranoia quaerulans is a symptom of many
diseases and occurs also in people whom we can not call
insane even if we leave out of consideration justifiable
attempts in that direction. According to my experience we
find this symptom most frequently in dementia prsecox, next
in paranoia, it is also not infrequently seen in hypomania,
and sometimes in the early stages of general paralysis.
Then there are people who can not be called insane, but
who from from excessive sen-
intellectual limitations or
sitiveness can not comprehend the rights of others. The
latter classes are in many cases not so easily separated
from the paranoic forms. Naturally there must be all

* Even a lawsuit which has been won may give rise to a paranoia quaerulans.
(Siemerling in Binswanger and Siemerling, Psychiatrie, pg. 150). Compare
there also among the causes of paranoia the affective ones: imprisonment,
strong emotional excitements through lawsuits, disappointments (p. 140). Fried-
mann recognizes cases of paranoia following actual persecution. Compare also
Kleist's Michael Kohlhas as an example of paranoia quaerulans, the genesis of
which seems fairly transparent. We would further mention the delusions of
being unjustly imprisoned, the delusional expectation of speedy liberation in
imprisoned paranoics and in other psychoses influenced by imprisonment.
 116

grades of transition from the sane to the quaerulant

paranoics.
In the foregoing probably all the complexes which may

arise in a civilized environment have been demonstrated as

possible origins of delusions with the single exception of
the desire for children. In the ideas of katatonics and of
the general paralytics the well known "cry for children"
plays a great part. Why not in paranoia? Unfortunately
I can not answer this question and must thus leave an im-
portant gap in my proof.* Perhaps some one else will be
more fortunate than I and may solve this difficult}*. But I
do not feel that, on account of this incompleteness, I
should throw over the whole view.

There yet remains for us to clearly state our view about

the limits of paranoia. According to Kraepelin man)* hal-
lucinations speak against paranoia. In other diseases,
especially dementia praecox, also in hysteria and in the
delusions and hallucinations caused by affects which we
find occasionally in normal people, it does not seem to be
essential whether the delusion comes to consciousness as a
thought or as a voice. In the course of many (not all)
paranoias hallucinations occur. In some cases they are
few, in others the)* appear in the form of a more or less out-
spoken hallucinatory confusion of several days or weeks
duration. But there are also cases in which hallucinations
preponderate but who are otherwise exactly like cases of
true paranoia inasmuch as an emotional and intellectual
deterioration can not be demonstrated for many years.
I must admit that circumstances have not allowed me to
investigate such cases over a sufficiently long period of time
with all our present diagnostic methods, but the usual
hospital observation in a great number of cases has given
me no reason for concluding that they are cases of dementia
praecox, even if it is easy in the great majority of instances

* The paranoic women who think they are the mother of God, if there are
such, I would place in the religious forms. Many mothers think their children
are persecuted by the teachers. Perhaps some of these may be paranoics.
 117

which were formerly called paranoia, to demonstrate the

cardinal symptoms of dementia praecox. It seems probable

to me that in many cases of true paranoia one can find hal-

lucinations, even of many senses, (even those of bodily
sensations and that between the clinical pictures of para-
)

noid dementia praecox and paranoia several other disorders

will be found to exist, but as yet only one has been shown
by Krsepelin, the presenile states of delusions of persecution.
Here is yet a rich field for observation.*
In spite of the fact that in the different forms of paranoia
we have shown a connection between the direction of
delusions and the affective complexes, the question as to
whether forms of paranoia have the same genesis is yet
all

open. paranoia is a mere functional disease caused by a

If
special combination of emotional make-up and external
experiences we can bring- them together under this point of
view as well as hysteria. But one must remember that the
interaction of emotional make-up and external experiences
also dominates the formation of delusions in other disorders,
may lead to the formation
so that entirely different processes
of similar delusions. We
can not therefore exclude that,
for example, the delusions of grandeur may be caused by a
different process than the delusions of persecution or those
of the paranoia quaerulans, not only so far as the affect but
also so far as assumed anatomical or chemical causes are
concerned. We may thus suppose that the assumed disease
process dominates the mood, just as general paralysis leads
to euphoria and this in turn to delusions of grandeur.
What would speak for a purely functional nature of
paranoia is the absence of intellectual deterioration as well
ground
as the fact that the disorder can be explained on the
of quantitativelychanged physiological processes. On the
other hand the incurability might be adduced as speaking
in favor of anatomical or chemical causes, yet we have
seen that the mental causes act for years, often even for a

* LiiKaro (L'ipocondria pensecutaria, lata forma tardiva pella demenza para-

noia'e : Kiv. di patologie new, e went, IX, 1Q04) has advanced the idea that the
severest and most characteristic signs of dementia praecox are seen in the
youngest cases at a time when the mind is not developed. In harmony with this
would be the fact that the paranoid forms occur usually in adult life and show
xelatively few " katatonic " symptoms.
 US
whole and Friedmann is even inclined to question
lifetime,
the incurability. It would be very desirable if he were
right. Perhaps the conception which we have above de-
veloped may give a point of departure for a more hopeful
treatment. Unfortunately I am myself at a loss to state
how such therapeutic measures should be carried out.

SUMMARY.
AFFECTIVITY.

All the intellectual processes, which are designated by

the term feeling, must be sharply separated from affectivity -
The intellectual feelings of Xahlowsky are intellectual pro-
cesses hunger, thirst, pain, etc., seem to be mixed pro-
;

cesses. They contain a sensation and a feeling associated

with it or, better expressed, a feeling produced by it. Other
bodily sensations, such as, for example, the sensation of
tension of our muscles have still other relations to the feel-
ings, ( = affectivity ),
because they not only influence affect-
ivity secondarily, but also are dominated by it and so are
themselves part of the symptomatology of the affects.
Only the affectivity in a narrow sense has in health}' and
morbid conditions the recognized actions on the functions-
of the body tears, heart's action, respiration, etc.
< and on I,

the inhibition and facilitation of the thoughts. In general

it is the dynamic force which determines our acts. The
reactions to an isolated sense-impression are by it general-
ized over our whole body and mind, it pushes aside oppos-
ing tendencies and thus gives the reaction force and extent.
It determines a concerted action of all our nervous and

psychic organs. It also increases the duration of the re-

action by lengthening action directed in a certain way
beyond the time of the primary stimulus. It is the cause of
a great many dissociations and transformations of our ego,
of certain forms of deliria, etc.
The shows a certain independence of intel-
affectivity
lectual processes in that the affectscan be transferred from
one process to another and in that different persons react so^
differently to the same intellectual process that one can not
 119

establish a form of affectivity. Moreover, the develop-

ment of the affectivity in children is entirely independent of
that of the intellect.
Thus there must be different types of reaction to experi-
ences associated with Unfortunately they have not
affects.
yet been studied. But it is quite possible that on such
peculiarity depends whether an individual will become
hysterical or paranoic or acquire some other functional
disease.
Attention may be regarded as one side of the affectivity.
It directs the associations exactly in the same way as do
the feelings and does not occur without affects.
it In
pathological conditions it is changed in the same sense as
the feelings.
In children the feelings may so plainly replace reflection
that the result of the affective facilitations and inhibitions
in associations does not differ from those produced by com-
plex logical reasoning. This is what we call instinctive
reactions.
In pathological conditions abnormalities of the affectivity
dominate entire clinical pictures. In organic psychoses
the affectivity has not undergone deterioration, as is often
asserted. On the contrary it reacts more easily than in
normal persons. The deterioration of the affectivity is not
real but secondary to and simulated by the deterioration of
the intellect. If a complicated concept can not be formed
or totally comprehended one can naturally not expect an
emotional reaction corresponding to it.
It is similar in alcoholics, while in epileptics the affec-

tivity is also preserved but instead of the lability found in

organic disorders it shows marked perseveration.
In idiocy we find all possible variations of the affectivity
as in normal individuals but in much wider limits. In
dementia praecox the affects are displaced in some way but
their expressions may still be demonstrated.

SUGGESTION.
Suggestion and affectivity have the same action on mind
and body, and, so far as we can judge, they also act by the
same means.
 120

In primitive conditions with animals, that which is

suggested are only affects.
Suggestion has the same action for a community of in-
dividuals as the affects have for the individual, it insures

unity and perseverance of actions, and produces a collective

affect.
Suggestibility as affectivity is developed in children
before intelligence.
The greater the feeling-value of an idea the more sug-
gestive power it has."
That which is described as the action of auto-suggestion
can just as correctly be described as the action of affect-
ivity .

Suggestibilityand affectivity have the same relation to-

attentionand also to pain sensations.
The knowledge of either property is not yet so advanced
that one can expect to bring the great or slight suggesti-
bility into connection with the presence or absence of a
definite kind of affectivity.
The crowd is for many reasons greater
suggestibility of a
than that of a single individual.
Suggestion is almost never entirely pure, uninfluenced
by other mental mechanisms.
We can best put our knowledge of the two properties in
one sentence by saying, Suggestibility is one side of affect-
ivity.

PARANOIA.

As yet, no one has succeeded in deriving paranoia from a

pathological affect. Suspicion especially which is held to
be the basis of paranoia is not an affect. It does not occur

in all forms of paranoia.

A general and primary affect-derangement is not demon-
strable in paranoia. The affect disorders which we plainly
see are secondary consequences of the delusions.
Xor does there exist in paranoia a general disorder of
perception or apperception, or a general change of memory
pictures, and the hypertrophy of the ego is not demon-
strable as a regular symptom in paranoia.
 '

121

That which is designated by the term hypertrophy of the

ego or egocentric character, is only the consequence of the
fact that in paranoia a complex associated with strong feel-
ings constantly dominates the mind. Just as in the case of
normal individuals whose mind, for some affective reason
or through constellation is focused on some definite idea, so
do here ordinary or more unusual experiences become
associated with the complex. In this way much that has
no relation to the person at all is associated with the com-
plex and thus arise delusions of reference and, because all
;

complexes associated with feelings bear a close relation to

the ego, the latter appears pushed into the foreground and
'
. '
therefore hypertrophic
'

Careful analysis of the genesis of delusions shows that

under the influence of a chronic affect, i. <?., the affect which
is connected with the above mentioned complex, errors

arise in exactly the same way as in normal individuals who

are emotionally stirred up. The errors become pathological
when they can no longer be corrected and when they extend
to other matters.
What is the fundamental cause of this we do not know.
Itmay have a chemical or anatomical foundation but the ;

cause may also be "functional," because the affectivity is

increased in a certain direction or because of its long dura-
tion or because the affect is constantly kept alive by the
circumstances or by an experience which has produced a
lasting impression.
As long as we do not know the underfying process of
paranoia we do not know whether the concept of paranoia
represents a disease entity. A condition of delusions of
grandeur and one of delusions of persecutions may be fun-
damentally different disorders. On the other hand it is
possible that a number of hallucinatory forms, which
Krsepelin does not class with paranoia, may be identical
with the usual forms of paranoia.